Transitional Long Term Care Coordinator

Amida Care is a Diversity, Equity, and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote, and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

This position is responsible utilization management of Long Term Support and Services (LTSS) Ensuring the safe and timely transfers of members from one level of care to another or from one type of health care setting to another.

ESSENTIAL FUNCTIONS
Essential functions are job duties and responsibilities that must be performed to accomplish the purpose/ goals of the job.

• Perform utilization management for LTSS: personal care services, consumer directed personal care services and personal emergency response services and consumer first choice option services.
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• Coordinate home health or personal care aid services requests identified while member is in hospital or associated with an inpatient stay.

• Collaborate and establish regular communication with Primary Care Physician (PCP) and Home Care Agencies to plan appropriate patient care.

• Collaborate with inpatient facilities and PCP to ensure appropriate level of LTSS care is provided.

• Coordinate transitional home health services to members who do not have a skilled nursing need but require personal aid services.

• Review physician’s order (M-11q form), nursing and other completed assessments (UAS) in accordance with the standards for levels of services and make final determination of the level and amount of care to be provided.

• Identify and advocate for structural and process changes needed at Program sites, the Plan, or In-Network Providers to improve quality of care and services to members.

MINIMUM JOB REQUIREMENTS

• Registered Nurse License or LPN certification with the addition of an equivalent combination clinical and managed care experience.

• Two (2) years’ prior home health care experience preferred.

• Two (2) years’ prior health care or managed care experience preferred.

• Two (2) years’ HIV/AIDS, medical or chronic care experience preferred.

• Demonstrated knowledge of Article 49- Utilization Review process preferred

• Strong knowledge of Microsoft Office (Word, Excel, and Access).

• Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.

• Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.

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