Service Coord III - LVN Valley

Driscoll Children's Hospital•Laredo, TX

About The Position

The Service Coordinator III supports members’ health, well-being, and independence through person-centered care planning and review of members’ service and support needs. The role helps ensure timely access to community-based Long-Term Services and Supports (LTSS) to prevent, delay, or reduce progression of chronic conditions and the need for institutionalization, and to help members remain safely in the community. Service coordination assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet members’ health and human-service needs, using advocacy, communication, and resource management to promote quality and cost-effective outcomes. The Service Coordinator III facilitates clinically appropriate and fiscally responsible care by communicating with physicians’ offices, families, caregivers, and other members of the health care team. The service coordination process considers medical, physical, behavioral, emotional, financial, psychosocial, and other needs, along with the member’s support system. The role focuses principally on STAR Kids members within Health Homes. The position also provides service coordination and care-resource coordination for members in the STAR Kids program, supports access to services and supports, monitors disease-management enrollment, handles SCIP calls, processes LTSS authorizations as directed, tracks workload and member status, and participates in health plan quality and committee activities. It may receive other reasonably related assignments from management.

Requirements

High school diploma or equivalent required.
At least a four-year college degree.
Current, active, and unrestricted Licensed Vocational Nurse (LVN) licensure.
Previous service coordination or case management experience.
At least three years of clinical experience, preferably pediatric, or one year of experience in managed care.
Direct experience working with children and young adults with similar conditions or behaviors in three of the last five years.
Maintain confidentiality and adhere to corporate compliance and integrity guidelines.
Comply with applicable federal, state, URAC, health-system, and health-plan regulatory and policy requirements.

Nice To Haves

Knowledge of Texas Medicaid criteria and guidelines.
Knowledge of managed care contracts and guidelines.
Knowledge of programs and services supporting the health and medical needs of children with disabilities.
Knowledge of reimbursement mechanisms, including third-party requirements.
Microsoft Office skills.
Experience as a case management support technician, medical-office or health-plan customer service representative, utilization review technician, or LTSS coordinator with DADS or DSHS.
At least a two-year college associate’s degree.
Previous experience in a managed care environment.
Previous experience with the State of Texas STAR+PLUS program or similar programs serving SSI members and children with disabilities.
Knowledge of the Medicare/Medicaid dual population.

Responsibilities

Provide evaluation of and assist in developing quality patient care services offered by DCHP.
Assist in establishing patient-care and professional-staff policies and procedures for DCHP.
Participate in long-range planning of services and programs offered by DCHP.
Provide service coordination within Health Homes and link members to their assigned service coordinator as required.
Coordinate care and efficient utilization of health care resources for STAR Kids members by communicating with physician offices, social workers, nurses, and other multidisciplinary team members.
Assist members in identifying, selecting, obtaining, coordinating, and using services and supports to enhance well-being, independence, community integration, and potential for supportive employment.
Enroll members in disease management and monitor and document progress.
Answer calls from members to the Service Coordination Integrated Pod (SCIP) and handle them appropriately.
Enter LTSS authorizations into the system as directed by Service Coordinators in the SCIP.
Communicate workload status and turnaround-time discrepancies to management as necessary; obtain approval from the manager or designee before redistributing workload.
Produce regular status reports tracking STAR Kids members.
Maintain thorough knowledge of the STAR Kids contract and meet its Service Coordination requirements.
Participate in health plan performance-improvement activities.
Participate in health plan committees as appropriate and when requested.
Accept other assignments from management and comply with management principles of delegation.
Maintain confidentiality and comply with applicable regulatory, contractual, health-system, health-plan, and corporate-compliance requirements and policies.