Long Term Care Coordinator I

Company: Sunshine State Health Plan
Location: Hialeah
Posted on: May 27, 2023

Job Description:

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment, and care coordination.Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development
Monitor delivery of services and follow-up with members, caregivers, or provider s through in person visits and telephonic contact
Authorize and coordinate referral for services
Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care
Assist in coordinating the development of informal or voluntary services to integrate into the member care plan
Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services
Assist member with filing and resolving complaints and appealsEducation/Experience: Bachelor's degree or Registered Nurse License and 2+ years of care management experience, Licensed Practical Nurse and 4+ years of care management experience, or 6+ years of care management experience. Home health, discharge planning, or long term care experience preferred. Licenses/Certifications: Valid driver's license. LPN or RN preferred.For Kansas plan only: Have at least a bachelor's degree in social work, rehabilitation, nursing, psychology, special education, gerontology, or related health and human services area or be a Registered Nurse (RN). Full-time experience in the field may be substituted for the degree at a rate of 6 months of full-time experience for each missing semester of college. Experience with persons participating in HCBS waiver programs is preferred.Pennsylvania requirements:Bachelor's degree or Registered Nurse License and 3+ years of experience in a social service or health care related setting, Licensed Practical Nurse and 5+ years of experience in a social service or health care related setting, or 7+ years of experience in a social service or health care related setting. Licenses/Certifications: Valid driver's license. LPN, LCSW or RN preferred.For Iowa plan only: Bachelor's degree or Registered Nurse License and 2+ years of experience in a social service or health care related setting OR Licensed Practical Nurse and 5+ years of experience in a social service or health care related setting, OR 7+ years of experience in a social service or health care related setting. For North Carolina only: --- Must reside in North Carolina--- Must be licensed practitioners--- Must be supervised by an RN, LCSW, or psychologist with trauma-based experience and training. Behavioral Health (BH) Managers and Full-Time BH Staff: These individuals shall be responsible for integrating into the clinical and care management teams to ensure Member's behavioral health needs are fully integrated into the service delivery system.--- Must reside in North Carolina--- Experience working in behavioral health managed care and clinical setting--- Licensed behavioral health professional practicing within their scopeFor MHS Indiana plan only: Care Coordinators shall be located in Indiana and licensed as applicable in Indiana. Care Coordinators must be (1) registered nurses in good standing, (2) have a Master's degree in social work, (3) possess a bachelor's degree in social work, psychology, special education, or counseling and have at least a minimum of one (1) years of experience in providing case management services to individuals who are older adults and/or individuals with physical or developmental disabilities and/or individuals determined to have a serious mental illness (SMI), or (4) be a licensed practical nurse (LPN) with a minimum of three years of clinical experience with older adults. A portion of the Contractor's Care Coordinators shall have experience in behavioral health so that they may appropriately assist members with behavioral health conditions.For Illinois Plan Only: In addition to the requirements above the employee working onPersons with Brain Injury Waiver Care Coordinators must meet one (1) of the seven (7) following requirements:1. Registered Nurse (RN) licensed in Illinois2. Certified or Licensed social worker3. Unlicensed social worker: minimum of bachelor's degree in social work, social sciences or counseling4. Vocational specialist: certified Rehabilitation counselor or at least three (3) years' experience working with people with disabilities5. Licensed Clinical Professional Counselor (LCPC)6. Licensed Professional Counselor (LPC)7. Certified Case Manager (CCM)Persons with HIV/AIDS Waiver Care Coordinators must meet one (1) of the three (3) following requirements:1. A Registered Nurse (RN) licensed in Illinois and a Bachelor's degree in nursing, social work, socialsciences or counseling or four (4) years of case management experience.2. Social worker with a Bachelor's degree in either social work, social sciences or counseling or a Masters of social work3. Individual with a bachelor's degree in a human services field with a minimum of five (5) years of case management experience.In addition, it is mandatory that the Care Coordinator for Enrollees within the Persons with HIV/AIDS Waiver have experience working with:--- Addictive and dysfunctional family systems--- Racial and ethnic minorities--- Homosexuals and bisexuals--- Persons with AIDS, and--- Substance abusersOur Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: Sunshine State Health Plan, Hialeah , Long Term Care Coordinator I, Other , Hialeah, Florida