LTSS Coordinator

LTSS Coordinator (2 roles)
ALTA is supporting a contract opportunity working remote located anywhere in the United States

The LTSS Coordinator II monitors and promotes effective utilization of long-term services and supports through clinical review and benefits management.

ALTA IT Services is a wholly owned subsidiary of System One, a leading provider of specialized workforce solutions and integrated services. ALTA is an established leader in IT Staffing and Services, for both government and commercial enterprises across the United States, specializing in Program & Project Management, Application Development, Cybersecurity, Data & Advanced Analytics, and Agile Transformation Services.

Essential Functions:

• Acts as point of contact with the Primary Care Manager, Medical Director, Provider, or other internal/external stakeholders to function in a collaborative role as a member of the interdisciplinary care team (ICT) to support coordination of long-term services and supports Ensures timely level of care completion and/or HCBS enrollment/disenrollment and/or review of HCBS services including home modification to maintain compliance with regulatory and accreditation regulations.
• Verifies eligibility, previous enrollment history, and demographics of members during case reviews.
• Completes prospective and retrospective review of requests for NF level of care determinations, respite care, waiver services, home modifications, and/or durable medical equipment per established processes.
• Coordinates, oversees, and provides input in the clinical documentation system for the issuance of approvals and denials of LTSS services.
• Responsible for clinical functions related to issuance of LTSS approvals and denials; supports appeals processes as requested.
• Coordinates with the Care Manager and/or providers to gather clinical documentation to complete LTSS reviews.
• Coordinates care with internal and external case management team members, providers, and/or other stakeholders to facilitate NF discharge planning in a timely and cost-effective manner.
• Reviews current documentation of contacts, treatment plans, case notes, referrals, and assessments in the electronic medical record according to current accreditation and compliance guidelines.
• Assists with development and implementation of updated care plans, by defining specific issues, prioritized goals and interventions as agreed to by all parties.
• Documents, identifies, and communicates with Health Partners, Care Managers, Medical Directors, Discharge Planners, Providers and/or other stakeholders as needed for care coordination and to establish safe discharge plans between levels of care when clinically appropriate.
• Closely collaborates with case management for any identified changes in eligibility for a member's assessed level of care and/or with any changes in level of care determinations identified by providers or other external stakeholders.
• Maintains knowledge of federal and state regulations governing Client, State Contracts and Provider Agreements, and Client Medicare and Medicaid benefits (including HCBS and nursing facility-based services). Attends and participates in interdisciplinary team meetings, State Hearings, and/or Medical Advisement meetings, when requested.
• Escalates identified care coordination needs to the appropriate case management team member(s) and leader(s)
• Identifies and refer quality issues to Quality Improvement
• Maintains appropriate documentation following protocols and guidelines of the MyCare Program
• Precepts and/or mentors' new staff.
• Participates in special projects or research, as requested.
• Maintains required reporting and assists with data analysis, as requested.
• Performs other job duties, as requested.

• Completion of an accredited Registered Nurse (RN) degree program or degree required to obtain Social Worker licensure in the state of Ohio is required.
• Bachelor's degree in nursing (BSN) or equivalent baccalaureate degree in healthcare field is preferred.
• Minimum of three (3) years of experience in case management and/or managed care is required.
• Experience in a Medicare and/or Medicaid managed care environment is preferred.
• Post-acute, home care, waiver, or acute clinical care experience is preferred.

• Ability to manage and meet workloads and deadlines
• Able to provide timely feedback to Client team members and business partners and prioritize provider and member engagement initiatives
• Intermediate proficiency level with Microsoft Office, Outlook, Word, and Excel
• Ability to communicate effectively with diverse population
• Ability to multi-task and work independently within a team environment
• Ability to collaborate with other internal team members to optimize birth and health outcomes for pregnant members
• Knowledge of community and state support and advocacy resources for population served
• Familiarity of state and federal healthcare regulations and environment
• Critical listening and thinking skills and willingness to be flexible
• Decision making and problem-solving skills
• Proper grammar use and phone etiquette
• Strong organizational and time management skills
• Ability to work within autonomous role, adapting and modifying plan of care of member as required

• Current, unrestricted Registered Nurse (RN)Licensed Social Worker (LSW), or Licensed Independent Social Worker (LISW) licensure in the state of Ohio is required.
• Case Management Certification (CCM) is preferred.