LTSS Coordinator

Job Locations US-MI-Southfield
Req No.
2018-2320
Category
Operations
Type
Regular Full-Time

Overview

ABOUT CONCERTO HEALTH

ConcertoHealth Inc. is the leading provider of specialized primary care and supporting clinical services for complex, frail, elderly, and dual-eligible patients. Operating exclusively in value-based agreements, ConcertoHealth provides high-touch, individualized care for patients, and deploys wraparound clinical resources to extend the reach of primary care practices. This comprehensive medical management solution, elevated by Concerto’s proprietary population health technology, improves overall healthcare quality and patient outcomes, benefitting payers and their provider networks.

 

Concerto delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. The Concerto name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. Our approach focuses on bringing harmony across the spectrum of a patient’s care, health, and dignity.

The company is headquartered in Irvine, Ca. For more information, please visit: www.concertohealth.com

JOB SUMMARY

The Long Term Supports and Services (LTSS) Coordinator, reporting to the Supervisor, LTSS is responsible for supporting and adhering to processes that result in our members receiving timely access to clinical, logistical, and long term supports and services. This role requires a high level of interaction with our members, LTSS team (LTSS Social Workers), Care Managers, and other treating providers. This role requires that the Coordinator:

  1. Perform at the direction of the LTSS team and Supervisor, including but not limited to activities such as facilitating schedules or coordination of services as assigned
  2. Generally, support the MI Health Link Home and Community-based Services (HCBS) Waiver and LTSS team
  3. Develop familiarity with members in order to proactively coordinate services, DME, support, and supplies
  4. Escalate any concerns regarding appropriate receipt of approved and authorized services, concerns regarding compliance with regulatory requirements or other identified member safety or clinical care risks to the Supervisor.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Within two (2) weeks after an authorization of any LTSS service is issued, actively follow up with rendering service provider (such as a “AAA”) to obtain an update on the status of member receiving the approved and authorized service(s), and document such follow up accordingly
  • Within three (3) weeks after authorization of any LTSS service is issued, follow up with member to confirm receipt of service and document such follow up accordingly. If member has not received the requested service, inform Supervisor in writing for escalation
  • Enter authorizations in TruCare for HCBS Waiver and Personal Care Services (PCS) and forward information to appropriate rendering service provider (such as “AAA”) and Resource Link (RL)
  • Provide the rendering service provider (“AAA”) and RL with the most up-to-date demographic information, and figuring units and calculations as it relates to authorized services
  • Track authorization expiration dates for when reassessments are needed
  • Monitor LTSS queue and review referrals for accuracy, proper documentation, and ensure that referrals are appropriate
  • Assign referrals to LTSS Social Workers in accordance with policy and/or other direction from Supervisor
  • Review HCBS Waiver applications and PCS recommendations for completeness and accuracy
  • Submit waiver applications to Michigan Department of Health and Human Services via Waiver Supports Application (WSA)
  • Serve as a WSA Approver
  • Provide waiver application and services follow up updates to Supervisor on a regular basis or as defined by Supervisor
  • Assist with Care Management staff training related to LTSS and waiver services
  • Perform ongoing communication with rendering service providers (such as “AAA’s”) to ensure proper coordination of services
  • Perform ongoing communication with Care Management staff to ensure accuracy of work and proper coordination of LTSS services
  • Receive documents from rendering service providers (AAAs) including progress notes, home modification estimates, critical incident reports, etc.
  • Once notified by Care Manager that a member may be eligible for LTSS, send referral to LTSS Social Worker for Level II Assessment
  • Notify LTSS Social Workers of when members need reassessment for PCS
  • Review home modification and LTSS service estimates with leadership and obtaining necessary approval for completion of services
  • Support the coordination and fulfillment of long term supports and services
  • Complete all mandatory regulatory and other required trainings including, but not limited to, Fraud, Waste and Abuse and Medicare General Compliance Training for First Tier, Downstream and Related Entities, model of care training, etc.
  • Inform appropriate staff regarding enrollment issues
  • Accompany LTSS Social Worker when it is appropriate to have more than one staff person making a member visit due to member circumstances
  • Follow up with members to ensure timely receipt of DME, supplies, and long term services and supports as assigned

 

Qualifications

  • Experience with supporting care coordination activities or similar member engagement/scheduling, referral coordination experience, no licensure requirement
  • Prefer prior experience in a care management or clinical setting
  • Demonstrates the ability to triage and apply critical thinking skills
  • Effective written and verbal communication
  • Knowledge of Medicare and Medicaid reporting requirements preferred
  • Ability to work in a Windows based computing environment
  • Ability to work in a fast paced, dynamic environment
  • Demonstrate ability to perform multiple concurrent tasks with minimal supervision and meet deadlines

 

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