Join our Community Wellness Team!

Long-Term Service and Supports Service Coordination will assist participants to gain access to services and support that meet their needs, most often referred to as waivers. The LTSS Service Coordinator works together with individuals and their person-centered planning team to identify, coordinate, and facilitate all necessary services regardless of the funding source.

If you are passionate about your career, enjoy helping people, and want the opportunity to make a difference in the lives of individuals within your community, apply now!

Job Description

Summary of Responsibilities:

Under the general direction of the unit Supervisor, this person provides service coordination services for eligible participants who are Medicaid eligible under Community Health Choices. Service Coordinators are responsible for providing ongoing service coordination services to eligible participants including ongoing monitoring to assure individual health, safety, and wellness; linkage to community and available resources; communicating information to participants; and developing and maintaining service plans outlining participant strengths, needs, and services. Eligible participants are 21 and older and have physical disabilities requiring long-term care needs. Eligible participants live in nursing facilities or in private community homes. Service Coordinators either serve participants living in private community homes (Community) or participants living in nursing homes (Nursing homes). Participants living in nursing homes are Medicaid-eligible through PA Health and Wellness. Participants living in private community homes are Medicaid-eligible through PA Health and Wellness or AmeriHealth Caritas. All service coordination activities are provided in accordance with all existing policies, procedures, and regulations and in accord with the mission and values of the company.

Essential Functions:

Assess needs and complete comprehensive assessments.

• Engage in ongoing assessment of participants include completing comprehensive assessments. As participant needs change, service coordinators are responsible for ensuring that needs are assessed when needed.

Linkage to services.

• Ensure that participants are referred to needed and/or approved services. Service coordinators ensure that the service referral process is completed when needed to ensure services are approved and authorized as needed.

Develop plans.

• Develop and maintain plans that outline participant strengths as needs. Plans are completed in accordance with current policy and established regulations.

Monitor.

• Provide ongoing monitoring activities to ensure adherence to plans, and satisfaction with services, and determine the ongoing safety and well-being of participants served.

Communicate and collaborate.

• Communicate priorities and information to participants and their identified team members. Service coordinators collaborate with all participants and team members to ensure and support the ongoing well-being, safety, and satisfaction of the participants served.

Verify eligibility.

• Service coordinators monitor and ensure that assigned participants maintain Medicaid eligibility. As/when/if needed, service coordinators collaborate with participants to resolve issues.

Documentation.

• Maintain accurate and up-to-date records including writing service notes for all services rendered. Documentation must meet current standards and practices as outlined by the organization.

Provide ongoing support and crisis intervention.

• Service coordinators are responsible for developing positive working relationships with participants and identified team members to ensure that needed ongoing support is provided. When needed, service coordinators engage in crisis intervention activities to ultimately support the safety of the participant.

Personal Characteristics:

Independent, Tech-Savvy, Responsive, Kind, Ethical, Motivated, Active Listener, Life-Long Learner, Adaptable, Confidential, Resourceful, Values, & Trustworthy

Education and Experience:

(1) Registered Nurse (RN); or (2) have a bachelor's degree in Social Work, Psychology, or other related fields with practicum experience: or (3) have at least three (3) or more years of experience in a social service or a healthcare related setting.

Employment Requirements:

Automobile and Valid Insurance, Valid Pennsylvania Driver's License, acceptable Motor Vehicle Record Check, Act 33 and Act 34 Clearances, FBI Fingerprint Clearance, Social Security Card, Immigration and Naturalization (I-9), Drug Screening Clearance.

Service Coordinators providing services within the Nursing Home project must complete TB testing.

Working Conditions:

Comfortable working within an open office environment and communicating through virtual technology. Travel throughout the coverage area is required and may occur in adverse conditions. Must be able to lift at least 15 pounds.