Service Coordinator III

Driscoll Children's Hospital•Corpus Christi, TX

20d

About The Position

The Service Coordinator III supports the STAR Kids program’s goal of maximizing members’ health, well-being, and independence. The role focuses on person-centered care coordination, reviewing members’ service and support needs in collaboration with assigned service coordinators, and helping ensure timely access to community-based Long-Term Services and Supports (LTSS). The work is intended to help prevent, delay, or reduce chronic-condition progression and institutionalization while supporting members to remain safely in the community. Service coordination involves assessing, planning, implementing, coordinating, monitoring, and evaluating options and services for members’ health and human-service needs. It includes advocacy, communication, resource management, and quality- and cost-conscious interventions. The Service Coordinator III facilitates clinically appropriate and fiscally responsible coordination with physician offices, families, caregivers, and other health care team members, addressing members’ medical, physical, behavioral, emotional, financial, psychosocial, and support-system needs. The position principally provides administrative care-coordination support to 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 the Service Coordination Pod phones and handles calls as directed by other Pod members. Employees may be assigned other reasonably related duties by Health Plan leadership.

Requirements

High school diploma or equivalent required.
At least 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 the utmost level of confidentiality.
Comply with regulatory requirements and intermittent reviews and audits, including those conducted by 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 personal 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 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.
Previous experience in a managed care environment.
At least a 4-year college degree and/or current, active, unrestricted LVN licensure.
Previous service coordination or case management experience.
Previous experience with the State of Texas STAR+PLUS program or similar programs involving SSI 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.
Provide outreach and care coordination to Level 3 members as warranted.
Coordinate care and efficient use of health care resources for STAR Kids members through communication with physician offices, social workers, nurses, and other multidisciplinary team members.
Assist members in identifying, selecting, obtaining, coordinating, and using services and supports that 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 tracking STAR Kids members and supporting the Pod manager and/or RN and social-work Service Coordinators.
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 by 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 as requested and comply with management principles of delegation.
Maintain confidentiality and comply with regulatory, health system, health plan, and corporate compliance requirements and policies.