Location:
Must reside in Harris County, Texas
Must be willing to travel in the service area
Summary:
The Star+Plus (LTSS) Service Coordinator Level 1 is responsible for overall management of member's case within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum.
Essential Functions:
- Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services and long-term services and supports.
- Identifies members for high-risk complications and coordinates care in conjunction with the member and the health care team.
- Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.
- Obtains a thorough and accurate member history to develop an individual care plan.
- Establishes short- and long-term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs.
- The RN has overall responsibility to develop the care plan for services for the member and ensures the member's access to those services.
- May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible.
- Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of care management treatment plans.
- May also assist in problem solving with providers, claims or service issues.
- Directs and/or supervises the work of any LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member by, for example, assigning appropriate tasks to the non-RN clinicians, verifying and interpreting member information obtained by these individuals, conducting additional assessments, as necessary, to develop, monitor, evaluate, and revise the member's care plan to meet the member's needs, and reviewing and providing input on the non-RN clinicians' performance on a regular basis.
- Provide input and/or data to direct supervisor/manager related to any internal or external mandatory audit or reporting.
- Serve as mentor, subject matter expert or preceptor to new staff.
- Involved in process improvement initiatives.
- Assist in problem solving with providers, claims or service issues.
- Actively contributes to achievement of departmental goals, as identified in Department’s annual business plan, including specific departmental process improvement plans and other duties as assigned
Knowledge, Skills, and Abilities:
Organizational Core Competencies:
All employees are responsible for understanding and demonstrating the client's core competencies:
- Customer Focus – Sustainability
- Reliability and Dependability – Employee Empowerment
- Honesty & Integrity – Sustainability
- Change Management – Affordability
- Team Work – Employee Empowerment
- Impact & Influence + Strategic Vision – Profitable Growth (Supervisory Employees)
- People and Team Development – Employee Empowerment (Supervisory Employees)
Job Family/Job Title Competencies:
The following competencies apply to the Entry Level of this job family:
- Problem Analysis
- Attention to Detail
- Critical Thinking
- Thoroughness
Additional competencies not indicated above:
- Above Average Verbal
- Exceptional Verbal
- Writing /Composing
Minimum Education:
Bachelor’s or Master’s degree based on required experience in health, psychology, sociology, social work, nursing, or another relevant human services field.
Minimum Experience:
Required Experience:
3-5 years nursing experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role
Preferred Experience: (if applicable)
Work experience focused on supporting members with IDD, TBI or MHSU and transitioning members into community living arrangements is preferred. Experience supervising a team is preferred.
Professional License or Certification Required/Preferred:
As noted above.
Other Position Characteristics:
Must Reside in/near Harris County, Texas
A valid active driver’s license and reliable transportation are required to be maintained for this position.
Job Type: Full-time
Pay: $50.00 - $55.00 per hour
Expected hours: 40 per week
Benefits:
Schedule:
- 8 hour shift
- Monday to Friday
Ability to Relocate:
- Harris County, TX: Relocate before starting work (Required)
Willingness to travel:
Work Location: In person
