Case Management Coordinator

General Description: 

Coordinators at TRE are the heart of this organization. Coordinators work in a variety of functions within the organization to assist and synchronize supports and services with the persons and potential persons we serve (and their families) through each phase of the person's life cycle and time with TRE. Coordinators work in a dynamic and highly regulated environment. Coordinators must remain agile in their approach while being responsive to the needs of the people we serve, maintain a strong understanding of TRE's Mission, Vision, and Values, and be strong stewards of the financial resources at TRE. 

Essential Duties/Responsibilities: 

Promote excellent internal and external customer service, through written and verbal communication, to all TRE stakeholders, with the intent of promoting TRE’s values through intentional communication strategies daily. 

Exhibit strong written and interpersonal communication skills to promote clarity of intent with all levels of communication daily. 

Develop a strong understanding of the rules and regulations that direct LTC and IHSS services to maintain compliance and best support the people served by TRE, daily. 

Critically analyze case documentation, behavioral and medical reports, guardianship paperwork, financial documents, and other data pertaining to promote the health and wellbeing of the people we serve daily. 

Enter case notes in multiple systems to promote documentation of all client contact, communication, records, and tasks completed for the people we serve daily. 

Organize and implement service plan development tasks (varies by position) in person, by phone, and/or through the use of technology (i.e. Outlook, Office 365, ZOOM, etc.) to promote and remain knowledgeable of the needs of the people we serve while maintaining compliance with rules, regulations, policies, and procedures daily. 

Develop positive relationships with all TRE stakeholders to promote TRE mission, vision, and values through all interactions daily. 

Maintain client and company records utilizing a variety of internal and external data management systems to support continuity of care, manage client contacts, support transparency, comply with HIPAA standards, and promote state and federal regulations daily. 

Cultivate an understanding of community resources in addition to those provided by TRE to support the additional needs of the people we serve weekly. 

Maintain HIPAA standards throughout all aspects of TRE engagement to comply with regulations and protect the privacy of the people we serve and TRE staff daily. 

Attend departmental and agency meetings and trainings in person, by phone, and/or through the use of technology (i.e. Outlook, Office 365, ZOOM, etc.) as specified by the meeting or training coordinator to maintain and improve your performance, knowledge, skills, and abilities to best support the people served by TRE weekly. 

Other Duties/Responsibilities: 

Support team members through providing coverage of essential and other duties to maintain quality of and continuity of services for the people served by TRE monthly. 

Participate in professional goal creation through the development and implementation of your career aspirations at TRE to further you performance, knowledge, understanding of the topics outlined in your career development plan quarterly. 

Adapt to a changing work environment due to last minute changes in state and federal rules and regulations that effect TRE’s policies and procedures to best support the people served by TRE annually or as needed. 

Assume other duties as assigned to promote the health and wellbeing of the people served by TRE and to promote the health and wellbeing of the organization annually or as needed.  

Team Duties/Responsibilities 

The Benefits Coordinator position helps to ensure financial eligibility for individuals receiving LTC Waiver services.  They coordinate with staff, clients, providers, and Department of Human Services (DHS) technicians to ensure clients remain financially eligible for Long Term Care Medicaid.  Submit CSRs (Level of Care/DSS1) and Redetermination documentation for each individual in services annually to the Department of Human Services (DHS) for continued eligibility. Additionally, they monitor cases in the Colorado Benefits Management System (CBMS) and resolve any concerns if a case has been discontinued which includes reaching out to various contacts, retrieving specific documentation and submitting it to DHS for the reinstatement of Long Term Care Medicaid. They also send tickets to Health Care Policy and Financing (HCPF) to correct errors in coding to ensure successful billing.  

The Billing Coordinator position is responsible for submitting all Targeted Case Management (TCM) billing through Medisked. They are responsible for reconciling the BUS and Medisked prior to submitting billing to ensure TCMs claimed match in both systems before billing is processed. They also will also process all re-bills, voided claims, denial claims, and Service Utilization. In addition to these duties, it is also their responsibility to work through billing issues submitted via the provider, Service Coordinator, or person in services. 

The Intake Coordinator is responsible for completing and documenting all initial in-home 100.2 assessments (functional needs assessment), Medicaid application, Arbor Review Group (ARG) applications and all corresponding applications for Long Term Care Medicaid waiver services on the individual’s behalf in compliance with the rules and regulations set for by Health Care Policy and Financing (HCPF).  

The Prior Authorization Request (PAR) Coordinators complete a thorough review of documentation and state databases to ensure Prior Authorization Requests (PARs) are in compliance with Rules and Regulations set forth by Health Care Policy and Financing (HCPF). They complete revisions, utilization, enrollments, and continued stay reviews in a timely manner and provide feedback when plans need additional information or documentation. They also partner with Provider Approved Service Agencies (PASA), Service Coordinators, and HCPF to complete PARs through a various means of communication. They also keep detailed information and track the progress of each PAR created, revised, and submitted. 

The Quality Coordinators complete reviews of Incident Reports for individuals served by TRE. Reviews of Incident Reports include looking for systemic issues, reporting and tracking of incidents and Critical Incidents to applicable governing entities (i.e. Health Care Policy and Financing or Colorado Department of Public Health and Environment), and trending of incidents. Quality Coordinators are also responsible for partnering with Adult/Child Protective Services and Law Enforcement to complete investigations of alleged incidents of Mistreatment. Additionally, Quality Coordinators assist with facilitating the Human Rights Committee. Quality Coordinators complete a thorough review of internal and external documentation of an individual’s support needs and strengths. They are responsible for reviewing documentation to look for inconsistencies, areas for further risk mitigation, and gaps in services/supports. They also request documentation and resources to assist with risk mitigation and resource connection for individuals in services. 

The Nursing Facilities Coordinators receive referrals from individuals looking to reside in a Nursing Facility from a variety of environments (Hospitals, Community, or other Nursing Facilities). They are responsible for completing an in-person assessment within a prescribed timeline to determine whether the individuals meet the necessary Level of Care for a Nursing Facility placement. Assessments are completed in the state required portal and additional documentation is sent to facilities and other community partners to facilitate admission dates to the facility of choice. 

The Home Health Team is the primary point of contact for all inquiries and information related to Long Term Home Health services for TRE clients. Collaborating with Home Health partner agencies TRE Service Coordinators, team members will review the Plan of Care (POC) and the Prior Authorization Request (PAR) along with Functional Eligibility assessments to ensure that the services are in alignment with eligibility requirements as outlined in Colorado Code of Regulation and avoids duplication of services with Home and Community Based Services. Team members will also liaison between TRE, Home Health Agencies, and Health Care Policy and Finance for information sharing. 

The Enrollment Coordinator is responsible for offering and completing enrollments into services as requested for HCBS-CES/SLS/DD/CHCBS/ CHRP/EBD/CLLI/CMHS/BI and corresponding state general fund programs. This includes all regional center, foster care, incarceration, and deinstitutionalization enrollments as needed. Ensure enrollments are completed within 90 days or less. The EC must complete and follow up with service referrals to provider agencies, state agencies, nursing facilities and community resources as appropriate in a timely manner, based on preferences and availability and ensure financial eligibility for services by communicating with the El Paso, Teller, Park, and Pueblo County Department of Human Services, and other entities such as families, Social Security Administration and Medicaid as needed. 

The Transfer Coordinator is responsible for organizing, coordinating, and executing the transfer of peoples leaving and entering TRE’s services to ensure continuity of care and support the needs of the people we serve while maintaining compliance with rules, regulations, policies, and procedures, daily. Communicates status of transfers with the people in services, their families, the appropriate SEP or CCB agency, and provider agencies to ensure transparency of shared information, daily. Communicates status of transfers with the people in services, their families, the appropriate SEP or CCB agency, and provider agencies to ensure transparency of shared information. Completing and following up with referrals for service by connecting with provider agencies, state agencies, nursing facilities, and/or community resources (as appropriate) to ensure continuity of care. 

The Ongoing Coordinator is responsible for conducting service plan development tasks and duties in and around the community with transportation provided by you, to include, but not limited to, meeting in private homes, group homes, state and federally managed facilities, and community locations like homeless shelters, daily/weekly. 

Job Qualifications: 

Knowledge, Skills and Abilities:  

Maintain a solid understanding of person-centered case management best practices and thinking. 

Must have a friendly disposition and positive attitude. 

Possess empathy for people with long-term care support needs. 

Independently organize daily tasks and activities to ensure strict deadlines are met while prioritizing emergencies as they arise. Qualified coordinators have a strong skillset with organization. 

Complete tasks using computer-based technology.  It is a must that every coordinator possesses a strong understanding of how to accurately use and manipulate Apple iPhones, desk phones, Microsoft 365 (TEAMS, Word, Excel, PowerPoint, SharePoint, OneDrive, etc.), Outlook, PDF software, and can use or learn to use additional plugins for these products.  In addition to these technologies, Coordinators are expected to learn several state and proprietary data bases to maintain accurate records. 

Use problem solving and critical thinking skills daily. 

Must possess cultural awareness, emotional intelligence, and be aware of unconscious biases. 

Education and Experience Requirements:   

Minimum: Bachelor’s degree in a human behavioral science or related field of study. If an individual does not meet the educational requirement, considerations may be made if the individual has experience working with long-term services and supports (LTSS) population, in a private or public agency, or has a combination of LTSS experience and education, demonstrating a strong emphasis in a human behavioral science field. Considerations may also be made for a combination of experience and education or 5 years of verifiable experience. 

Preferred: In addition to the minimum standards, one to three years’ experience in a case management environment. Experience working with or possessing knowledge of family dynamics. Knowledge of community services and resource development. Working knowledge of Medicaid Waiver programs and requirements. 

Material and Equipment Directly Used: Computers, Printers, Copy Machines, Surface Pro/tablets, Cell phones, etc. 

Working Environment and Physical Activities: Frequent changes in environments occur with some positions, but most positions maintain a work setting in the office or remotely. Work settings may also include working from the office, at home, or in another location in the community (library, coffee shop, etc.). Navigation Coordinator meetings occur in a variety of settings like private homes, group homes, state and federally managed facilities, and community locations like homeless shelters, and the settings include occasionally working with or in proximity to people who are incarcerate for a variety of crimes which may include violent crimes and sex offences. There is a frequent need to stand, sit, and walk indoors (and outdoors with the Navigation Coordinator position in a variety of weather conditions while carrying up to 10 pounds of equipment), and there is an occasional need to lift 20 pounds. (ADA accommodations at the request of the employee.) A working vehicle, valid CO driver’s license (unless active Military family), and auto insurance coverage with bodily injury and property damage liability coverage ($100,000/$300,000/$100,000 coverage recommended) is recommended.