Service Coord III - LVN Valley

DRISCOLL HEALTH PLAN • Brownsville, TX

102d

About The Position

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 planning and will review member’s services and supports needs, all 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 III facilitates clinically appropriate and fiscally responsible patient care through communication with the physician offices involved in the members 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. The Service Coordinator III will focus principally on the needs of STAR Kids members within Health Homes.

Requirements

• Experience as a case management support technician, customer service representative in a medical office or health plan, utilization review technician, or LTSS coordinator with DADS or DSHS preferred.
• High school diploma or equivalent required.
• At least a 2-year college Associate’s Degree preferred.
• Previous experience in a managed care environment preferred.
• Direct experience working with children and young adults with similar conditions or behaviors in three of the last five years.
• At least a 4-year college degree and current, active, and unrestricted licensure as a Licensed Vocation Nurse (LVN).
• Previous service coordination or case management experience.
• Minimum 3 years of clinical experience (pediatric preferred) or 1 year experience in managed care.
• Previous experience with the State of Texas STAR+PLUS program or similar programs dealing with SSI and disabled children preferred.
• Knowledge of the Medicare/Medicaid dual population preferred.

Nice To Haves

• 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.

Responsibilities

• Function in an advisory role to the Medical Directors and Medical Management Committee.
• Provide evaluation of and assist in the development of quality patient care services offered by DCHP.
• Assist in the establishment of patient care and professional staff policies and procedures of DCHP.
• Participate in long-range planning of services and/or programs offered by DCHP.
• Provide service coordination within the Health Homes and link Members to assigned service coordinator as required.
• Coordinate care and efficient utilization of health care resources for patients identified in the STAR Kids program.
• Provide the member with initial and ongoing assistance identifying, selecting, obtaining, coordinating, and using services and supports.
• Enroll member in disease management and monitor and document progress.
• Answer Service Coordination Integrated Pod (SCIP) phone calls from the members and handle appropriately.
• Enter LTSS authorizations into the system per the direction of the Service Coordinators in the SCIP.
• Communicate with management regarding status of current workload and turn-around time discrepancies.
• Produce status reports on a regular basis to track members in STAR Kids.
• Ensure thorough knowledge of the STAR Kids contract and meet all Service Coordination contract requirements.
• Participate in health plan’s performance improvement activities.
• Participate in health plan committees as appropriate and on request.
• Accept other assignments from management as requested.

Benefits

• Compassionate work environment.
• Opportunities for professional development.
• Supportive team culture.

What This Job Offers

• Education Level: Associate degree
• Number of Employees: 51-100 employees