The Service Coordinator III program supports maximizing the member’s health, well-being, and independence. The Service Coordinator III will focus on person-centered care coordination and will review member’s services and supports needs in collaboration with the assigned service coordinator to assure timely community-based Long-Term Services and Supports (LTSS) to prevent, delay, or reduce the progression of chronic conditions and the need for institutionalization and to maintain the member safely in the community.
Requirements
- Knowledge in Texas Medicaid criteria/guidelines preferred.
- Knowledge about managed care contracts/guidelines preferred.
- Knowledge of programs and services required to support the health and medical needs of disabled children preferred.
- Knowledge of various reimbursement mechanisms, including third party requirements preferred.
- Microsoft Office skills preferred.
- Maintains utmost level of confidentiality at all times.
- Maintains compliance with regulatory agencies that conduct intermittent reviews and audits to ensure contractual and regulatory compliance with Federal, State entities as well URAC.
- Implements and adheres to Health System and Health Plan policies and procedures for the medically complex members (STAR Kids).
- Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.
- Provide evaluation of and administratively assist in the development of quality patient care services offered by DHP.
- Assist in the establishment of patient care and professional staff policies and procedures of DHP; and
- Participate in long-range planning of services and/or programs offered by DHP.
- Provides administrative support for care coordination to the assigned Service Coordinator RN’s and SW’s
- Provides outreach and care coordination to Level 3 members as warranted.
- Coordinates care and efficient utilization of health care resources for patients identified in the STAR Kids program through communication with other members of the health care team, including physician offices, social workers, nurses, and other multidisciplinary team members as appropriate to obtain optimal outcomes for members.
- Provide the member with initial and ongoing assistance identifying, selecting, obtaining, coordinating, and using services and supports to enhance the member’s wellbeing, independence, integration into the community, and potential for supportive employment.
- Refers member to disease management team.
- Answers Service Coordination Pod ACD phone calls from the members who call the Service Coordination Pods and handles appropriately.
- Communicates with management regarding status of current workload and turn-around time discrepancies as necessary.
- Must obtain approval from manager or designee to any redistribution of workload.
- Produce status reports on a regular basis to track members in STAR Kids and support the POD manager and/or Service Coordinators RN and SW.
- Ensure thorough knowledge of the STAR Kids contract and meet all Service Coordination contract requirements.
- Participates in health plan’s performance improvement activities. Participates in health plan committees as appropriate and on request.
- Accepts other assignments from management as requested and complies with basic management principals of delegation.
Benefits
- Health insurance
- Paid time off
- Retirement plan
