Anthem, Inc. LTSS Service Coordinator-Auditor in Kissimmee, Florida
SHIFT: Day Job
LTSS Service Coordinator - Auditor
Location: Remote work at home; travel; Must live in any of the following counties: Broward, Dade, Hillsborough, Pasco, Pinellas, Hardee, Highlands, Manatee, Polk, Orange, Seminole, Osceola, Brevard
Be part of an extraordinary team:
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Build the Possibilities. Make an extraordinary impact.
Amerigroup is a proud member of Anthem’s family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services to Medicaid plans in partnership with blue cross blue shield plans.
How you will make an impact:
The LTSS Auditor is responsible for auditing member individual service plans within the scope of position, as required by applicable state law and contract. The audit process does not involve clinical judgment.
Primary duties may include, but are not limited to:
Audits program needs assessments and member’s long term service and support needs to ensure that established service plans are appropriate. Audits to determine whether members with potential clinical health care needs (including, but not limited to, potential for high risk complications) are coordinated with the clinical healthcare management and interdisciplinary team.
Audits to determine whether the non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, are being met to insure cost effective and efficient utilization of long term services and supports.
Audits the short and long term service and support goals that were established for the member and ensures the level of service and/or waiver programs are appropriate.
Documents audit findings, identifies issues and informs management.
Assesses and identifies training opportunities for the staff.
Auditors shall meet one of the following qualifications:
Auditors with the following qualifications shall also have a minimum of two (2) years of case management experience:
(a) Bachelor’s degree in social work, sociology, psychology, gerontology, or a related social services field
(b) Registered nurse, licensed to practice in the State
(c) Bachelor’s degree in a field other than social science
Auditors with a master’s degree in social work, sociology, psychology, gerontology, or a related social services field may substitute experience obtained through a practicum, internship, or clinical rotation on an equivalent basis for up to one (1) year of the experience requirements.
Auditors with the following qualifications shall also have a minimum of four (4) years of relevant experience:
Licensed Practical Nurse, licensed to practice in the State.
Auditors without the aforementioned qualifications may substitute professional human service experience on a year for year basis for the educational requirement.
Auditors without a bachelor’s degree shall have a minimum of six (6) years of relevant experience.
All Auditors are required to obtain a successful Level II criminal history screening and/or background investigation.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact email@example.com for assistance.