Service Coordinator III

DRISCOLL HEALTH PLAN•Corpus Christi, TX

21d

About The Position

The Service Coordinator III program supports members in maximizing their health, well-being, and independence. This role focuses on person-centered care coordination, reviewing members’ service and support needs in collaboration with assigned service coordinators, and helping ensure timely community-based Long-Term Services and Supports (LTSS). The goal is to prevent, delay, or reduce the progression of chronic conditions and the need for institutionalization while helping members remain safely in the community. Service coordination assesses, plans, implements, coordinates, monitors, and evaluates services and options needed to address members’ health and human-service needs. The role promotes advocacy, communication, resource management, and quality, cost-effective interventions and outcomes. The Service Coordinator III facilitates clinically appropriate and fiscally responsible coordination by communicating with physicians, family members, caregivers, and other members of the health care team. Coordination considers medical, physical, behavioral, emotional, financial, psychosocial, and other needs, as well as the member’s support system. The position primarily provides administrative support to assigned RN and social work service coordinators, or performs contractual outreach calls to Level 3 STAR Kids members as assigned by a supervisor. The Service Coordinator III also staffs the Service Coordination Pod phones and handles calls appropriately under the direction of other Pod members.

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 requirements and reviews or audits, including those conducted by Federal and State entities and URAC.
Implement and adhere to Health System and Health Plan policies and procedures for medically complex STAR Kids members.
Demonstrate ethical business practices and actions consistent 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 disabled children.
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 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 and disabled children.
Knowledge of the Medicare/Medicaid dual population.

Responsibilities

Provide administrative support for care coordination to assigned Service Coordinator RNs and social workers.
Provide outreach and care coordination to Level 3 members as warranted.
Coordinate care and efficient use 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.
Refer members to the disease management team.
Answer Service Coordination Pod ACD phone calls from members and handle them appropriately.
Communicate workload status and turnaround-time discrepancies to management; obtain approval from a manager or designee before redistributing workload.
Produce regular status reports to track STAR Kids members and support the Pod manager and Service Coordinator RNs and social workers.
Maintain thorough knowledge of the STAR Kids contract and meet Service Coordination contract requirements.
Participate in health plan performance-improvement activities.
Participate in health plan committees as appropriate and when requested.
Function in an advisory role to Medical Directors and the Medical Management Committee, including evaluating and administratively assisting with development of quality patient-care services, assisting with patient-care and professional-staff policies and procedures, and participating in long-range service or program planning.
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.