Service Coordinator III Valley

General Purpose of Job:

The Service Coordinator III program supports maximizing the members health well- being and independence. The Service Coordinator III will focus on person-centered care coordination and will review members services and supports needs in collaboration with the assigned service coordinator to assure timely community-based Long-Term Services and Supports (LTSS) to prevent delay or reduce the progression of chronic conditions and the need for institutionalization and to maintain the member safely in the community.

Service Coordination is a collaborative practice that assesses plans implements coordinates monitors and evaluates the options and services required to meet the members health and human services needs. It is characterized by advocacy communication and resource management and promotes quality and cost-effective interventions and outcomes. The Service Coordinator III facilitates clinically appropriate and fiscally responsible patient care coordination through communication with the physician offices involved in the members care family care giver and all other members of the health care team. The Service Coordination process is holistic in its coverage of the

members situation and addresses medical physical behavioral emotional financial psychosocial and other needs as well as that as the support system. The Service Coordinator III will focus principally on care coordination administrative support for the assigned Service coordination (RN and SW) or perform contractual outreach call of Level 3 STAR Kids members as assigned by supervisor. The Service Coordinator III will staff the phones for the Service Coordination Pod and handle appropriately and at the direction of the other members of the Service Coordination Pod.

Essential Duties and Responsibilities:

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by Health Plan leadership as required.

Knowledge Skills and Abilities:

1. Knowledge in Texas Medicaid criteria/guidelines preferred.

2. Knowledge about managed care contracts/guidelines preferred.

3. Knowledge of programs and services required to support the health and medical needs of disabled children preferred.

4. Knowledge of various reimbursement mechanisms including third party requirements preferred.

5. Microsoft Office skills preferred.

6. Maintains utmost level of confidentiality at all times.

7. Maintains compliance with regulatory agencies that conduct intermittent reviews and audits to ensure contractual and regulatory compliance with Federal State entities as well URAC.

8. Implements and adheres to Health System and Health Plan policies and procedures for the medically complex members (STAR Kids).

9. Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.

Responsibilities:

1. Function in an advisory role to the Medical Directors and Medical Management Committee in the following areas:

a. Provide evaluation of and administratively assist in the development of quality patient care services offered by DHP.

b. Assist in the establishment of patient care and professional staff policies and procedures of DHP; and

c. Participate in long-range planning of services and/or programs offered by DHP.

2. This position shall be responsible for the following aspects of the program:

a. Provides administrative support for care coordination to the assigned Service Coordinator RNs and SWs

b. Provides outreach and care coordination to Level 3 members as warranted.

c. Coordinates care and efficient utilization of health care resources for patients identified in the STAR Kids program through communication with other members of the health care team including physician offices social workers nurses and other multidisciplinary team members as appropriate to obtain optimal outcomes for members.

d. Provide the member with initial and ongoing assistance identifying selecting obtaining coordinating and using services and supports to enhance the members wellbeing independence integration into the community and potential for supportive employment.

e. Refers member to disease management team.

f. Answers Service Coordination Pod ACD phone calls from the members who call the Service Coordination Pods and handles appropriately.

g. Communicates with management regarding status of current workload and turn-around time discrepancies as necessary. Must obtain approval from manager or designee to any redistribution of workload.

h. Produce status reports on a regular basis to track members in STAR Kids and support the POD manager and/or Service Coordinators RN and SW.

i. Ensure thorough knowledge of the STAR Kids contract and meet all Service

Coordination contract requirements.

j. Participates in health plans performance improvement activities.

k. Participates in health plan committees as appropriate and on request.

3. Accepts other assignments from management as requested and complies with basic management principals of delegation.

Education and/or Experience:

Experience as a case management support technician a customer service

representative in a medical office or health plan utilization review technician or an LTSS coordinator with DADS or DSHS preferred.

High school diploma or equivalent required.

At least a 2-year college Associates Degree preferred.

Previous experience in a managed care environment preferred.

Direct experience working with children and young adults with similar conditions or behaviors in three of the last five years required if performing contractual contact to Level 3 members.

At least a 4-year college degree and/or current active and unrestricted licensure as a Licensed Vocation Nurse (LVN) preferred.

Previous service coordination or case management experience preferred.

Minimum 3 years of clinical experience (pediatric preferred) or 1 year experience in managed care.

Previous experience with the State of Texas STARPLUS program or similar programs dealing with SSI and disabled children preferred

Knowledge of the Medicare/Medicaid dual population preferred