Service Coordinator III Valley

DRISCOLL HEALTH PLAN • McAllen, TX

1d

About The Position

The Service Coordinator III program supports members’ health, well-being, and independence through person-centered care coordination. In collaboration with the assigned service coordinator, the role reviews members’ service and support needs to help ensure timely community-based Long-Term Services and Supports (LTSS), prevent or delay the progression of chronic conditions and the need for institutionalization, and help members remain safely in the community.

Service coordination involves assessing, planning, implementing, coordinating, monitoring, and evaluating options and services needed to meet members’ health and human services needs. The position promotes advocacy, communication, resource management, and quality, cost-effective interventions and outcomes. It facilitates clinically appropriate and fiscally responsible care coordination through communication with physicians, families, caregivers, and other members of the health care team. Coordination takes a holistic approach to members’ medical, physical, behavioral, emotional, financial, psychosocial, and other needs, as well as their support systems.

The Service Coordinator III principally provides administrative support for assigned RN and social work service coordinators or conducts contractual outreach calls to Level 3 STAR Kids members as assigned by a supervisor. The role also staffs phones for the Service Coordination Pod and handles matters appropriately under the direction of other Pod members. Employees may perform other reasonably related duties assigned by Health Plan leadership. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Requirements

• High school diploma or equivalent required.
• Minimum of 3 years of clinical experience, preferably pediatric, or 1 year of experience in managed care.
• If performing contractual contact to Level 3 members, direct experience working with children and young adults with similar conditions or behaviors in three of the last five years is required.
• Maintain confidentiality at all times.
• Comply with regulatory and contractual requirements, including those of Federal and State entities and URAC.
• Adhere to Health System and Health Plan policies and procedures for medically complex STAR Kids members.
• Demonstrate ethical business practices and comply with Corporate Compliance and integrity guidelines.

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 2-year college Associate’s Degree.
• At least a 4-year college degree and/or current, active, unrestricted LVN licensure.
• Previous experience in a managed care environment.
• Previous service coordination or case management experience.
• 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 administrative care coordination support to assigned RN and social work service coordinators.
• Review members’ service and support needs in collaboration with the assigned service coordinator.
• Support timely community-based LTSS to help members remain safely in the community and prevent or delay worsening chronic conditions or institutionalization.
• Conduct contractual outreach calls to Level 3 STAR Kids members when assigned by a supervisor.
• Staff the Service Coordination Pod phones and handle matters under the direction of other Pod members.
• Facilitate coordination among physician offices, family members, caregivers, and other health care team members.
• Maintain confidentiality and comply with applicable regulatory, contractual, Health System, and Health Plan requirements and policies.
• Perform other reasonably related duties as assigned by Health Plan leadership.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED