Specialist, Long-Term Services & Supports

Job Summary

Provides non-clinical operational support for long-term services and supports activities. Works in collaboration with multidisciplinary team coordinating member care across the continuum to ensure member progress toward desired outcomes, and contributes to overarching strategy to provide safe, efficient and cost-effective member care.

Essential Job Duties

• Provides non-clinical operational support for the long-term services and supports (LTSS) function.
• Addresses questions and assists with care coordination needs.
• Actively contributes to collaborative care planning efforts.
• Identifies service gaps and escalates issues or concerns through appropriate channels.
• Coordinates with LTSS programs and providers to ensure compliance with established agreements.
• May be responsible to monitor team mailbox; responds to all inquiries in a timely and professional manner.
• Tracks regulatory inquiries and notifications from agencies including state departments of health, and ensures timely communications escalation to LTSS leadership.
• May be responsible to review community-based adult services (CBAS) updates including discharges and applicable notifications to determine if care management outreach is needed.
• May coordinate skilled nursing facility (SNF) assignment of long-term care custodial members.
• Reviews authorization statuses for LTC members who are no longer residing in long-term facilities, and ensures that authorizations are appropriately closed in a timely manner.
• Collaborates cross-functionally with contracting, operations, and enrollment teams to address member long-term care (LTC) needs as they arise, and ensure alignment across departments.
• Supports the preparation of LTC reports for internal teams and external agencies.
• May complete follow-up calls to members after authorizations to ensure that services have begun and/or adaptive devices have been delivered, and member is satisfied.
• May review home modification needs and interface with contractors regarding bidding processes, follow-up after home modifications are completed, and notify care management of issues regarding the home modification process.
• May authorize and coordinate delivery of durable medical equipment and/or supplies for members transitioning out of the nursing home, under the direction of the care manager.
• Enters authorizations into applicable health care management system platform as required.
• Measures and tracks activities occurring during the care management processes, and reports results to leadership.
• Establishes and maintains relationships with LTSS entities/providers in assigned market(s).
• May be responsible for follow-up and notification to providers related to issues with supplies/services; communicates back to the care manager/leadership on related issues and resolutions.
• May be responsible to initiate member referrals for Medicare/waiver processes in cases where member is not already Medicare or waiver established.
• Maintains confidentiality and complies with the Health Insurance Portability and Accountability Act (HIPAA).
• Attends outreach meetings as assigned.
• Facilitates other administrative support duties as needed.
• 15-20% local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 1 year experience in an administrative support role in health care, or equivalent combination of relevant education and experience.
• An associate's degree in a health-related field may be required in certain states (dependent upon state/contractual requirements).
• Ability to handle multiple work tasks, prioritize and problem-solve.
• Strong customer service skills.
• Effective verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.