Service Coord III - LVN Valley

DRISCOLL HEALTH PLAN•Laredo, TX

About The Position

The Service Coordinator III supports STAR Kids members within Health Homes by maximizing their health, well-being, and independence. The position focuses on person-centered care planning and reviewing 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 institutionalization, and support members in remaining safely in the community. Service coordination is a collaborative practice involving assessment, planning, implementation, coordination, monitoring, and evaluation of services needed to meet 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 care through communication with physicians, families, caregivers, and other health care team members. Coordination addresses members’ medical, physical, behavioral, emotional, financial, psychosocial, and other needs, as well as their support systems.

Requirements

High school diploma or equivalent required.
At least a four-year college degree and current, active, unrestricted Licensed Vocational Nurse (LVN) licensure.
Direct experience working with children and young adults with similar conditions or behaviors in three of the last five years.
Previous service coordination or case management experience.
At least three years of clinical experience, preferably pediatric, or one year of experience in managed care.
Maintain confidentiality and comply with regulatory and organizational requirements.

Nice To Haves

At least a two-year college associate’s degree.
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.
Previous experience in a managed care environment.
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.
Previous experience with the State of Texas STAR+PLUS program or similar programs serving SSI recipients and children with disabilities.
Knowledge of the Medicare/Medicaid dual-eligible population.

Responsibilities

Provide service coordination within Health Homes and link members to assigned service coordinators as required.
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 promote well-being, independence, community integration, and potential for supportive employment.
Enroll members in disease management programs and monitor and document their progress.
Answer Service Coordination Integrated Pod (SCIP) phone calls from members 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 and obtain approval before workload redistribution.
Produce regular status reports tracking STAR Kids members.
Maintain thorough knowledge of the STAR Kids contract and meet service coordination contract requirements.
Participate in health plan performance improvement activities and committees as appropriate or requested.
Advise Medical Directors and the Medical Management Committee by evaluating and helping develop quality patient care services, assisting with patient care and professional staff policies and procedures, and participating in long-range service and program planning.
Accept other management assignments and comply with management delegation principles.
Maintain confidentiality and comply with applicable regulatory, contractual, health system, health plan, and corporate compliance requirements and policies.