Serv Coord II Licensed MSW Val

DRISCOLL HEALTH PLAN • McAllen, TX

7d

About The Position

The Service Coordinator II supports maximizing the Member’s health, wellbeing, and independence. The Service Coordinator II will focus on person-centered care planning and will assess the Member’s services and support needs, 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. Service Coordination is a collaborative practice that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the Member’s health and human service’s needs. It is characterized by advocacy, communication and resource management and promotes quality and cost-effective interventions and outcomes. The Service Coordinator Il facilitates clinically appropriate and fiscally responsible patient care through communication with the physicians involved in the Member’s care, family, care giver, and all other members of the health care team. The Service Coordination process is holistic in its coverage of the Member’s situation and addresses medical, physical, behavioral, emotional, financial, psychosocial, and other needs, as well as that as the support system. This Service Coordinator will be designated as the named Service Coordinator for Level 1 and/or Level 2 Members with primarily a behavioral health diagnosis not on MDCP or requiring private duty nursing services. The Service Coordinator II coordinates for any Member that requires coordination of behavioral health services. A named Service Coordinator for a Level I Member must be a licensed social worker. A named Service Coordinator for a Level II Member may have an undergraduate or graduate degree in social work. In order to complete the STAR Kids Screening and Assessment Instrument (SAI) modules for the Core or Personal Care Assessment Module (PCAM), the Service Coordinator must hold the credentials of MSW, LMSW, LCSW, or LBSW.

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.
• Knowledge of various utilization criteria sets (e.g. InterQual) 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 Members with special health care needs (STAR Kids).
• Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.
• Behavioral Health experience preferred.
• Pediatric experience preferred or experiencing working with children with special health care needs that will be in the STAR Kids program.
• Minimum of a 4-year college degree , with graduate or undergraduate degree in social work.
• Active and unrestricted licensure as a Licensed Clinical Social Work (LCSW); or Masters in Social Work (MSW) or Licensed Masters in Social Work (LMSW) or Licensed Bachelors in Social Work (LBSW) preferred
• Minimum 2 years of clinical experience (pediatric preferred) or 1 year experience in managed care or case management.
• Current, active and unrestricted licensure in Texas as a Social Worker preferred
• Current driver’s license and insurance

Nice To Haves

• Previous experience with the State of Texas STAR+PLUS program or similar programs dealing with SSI and children with disabilities preferred.
• Knowledge of the Medicare/Medicaid dual population preferred
• Strong behavioral health experience and knowledge.

Responsibilities

• Function in an advisory role to the Medical Directors and Medical Management Committee in the following areas: a. Provide evaluation of and assist in the development of quality patient care services offered by DCHP. b. Assist in the establishment of patient care and professional staff policies and procedures of DCHP; and c. Participate in long-range planning of services and/or programs offered by DCHP.
• This position shall be responsible for the following aspects of the program: a. A LMSW, LCSW, or LBSW serves as the named Service Coordinator for Level 1 Members and completes the SAI Core and PCAM modules for Members with primary behavioral health conditions. b. A licensed (LMSW, LCSW or LBSW), unlicensed social worker (MSW or BSW) or person with undergraduate or graduate degree in social work or related field may serve as a named Service Coordinator for a Level II Member with primary behavioral health conditions. The Service Coordinator II will conducted the SK SAI , complete the service plan (ISP) and other assessments required. c. Assesses Member behavioral health needs and coordinates with the other Service Coordinators to implement goals and objectives to meet the needs of the Member. d. Utilizes processes to include physical, needs, and psychosocial assessment, planning, implementation, coordination, monitoring and evaluation. e. Participates in timely completion of assessment activities meeting State contractual requirements for STAR Kids. f. 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. g. Coordinates with all other STAR Kids waiver programs. h. Enrolls Member in disease management and monitors and documents progress. i. 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 physicians, social workers, nurses, and other multidisciplinary team Members as appropriate to obtain optimal outcomes for Members. j. Coordinates the Member’s intake process by reviewing the physician orders, confirming eligibility, benefits, and coordinating the completion of all associated paperwork while orienting Members and family to managed care service coordination. k. Complete documentation about a Member’s service coordination plan of care, progress toward meeting care goals, outcomes, case reports, etc. 1. Ensure thorough knowledge of the STAR Kids contract and meet all Service Coordination contract requirements. m. Negotiates with vendors when necessary for services/equipment. n. Ensure appropriate referrals to agencies and assistance programs are completed. o. 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. p. Must be knowledgeable about managed care Medicare/Medicaid criteria/guidelines. q. Must be knowledgeable of data-driven decision making tools and their use. r. Must have a working knowledge of various reimbursement mechanisms including third party requirements and Medicare. s. Produce status reports on a regular basis to track Members in STAR Kids. t. Participates in health plan’s performance improvement activities. u. Participates in health plan committees as appropriate and on request. v. Completion of multiple evidence-based assessment tools to include but not limited to; STAR KIDS Screening and Assessment Instrument (SAI), STAR KIDS Individual Service Plan (ISP), PHQ- 9, Driscoll Behavioral Health Screening Assessment, and Generalized Anxiety Disorder Assessment.
• This position shall also be responsible to perform other such professional services as may be requested by DHP from time to time.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 101-250 employees