Additional Information
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General Purpose of Job:
The Service Coordinator III program supports maximizing the member's health, well-being, and independence. The Service Coordinator III will focus on person-centered care planning and will review member's services and supports needs, all 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 member's health and human service's 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 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 member's 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 the needs of STAR Kids members within Health Homes.
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:
Knowledge in Texas Medicaid criteria/guidelines preferred. Knowledge about managed care contracts/guidelines preferred. Knowledge of programs and services required to support the health and medical needs of disabled children preferred. Knowledge of various reimbursement mechanisms, including third party requirements preferred. Microsoft Office skills preferred. Maintains utmost level of confidentiality at all times. Maintains compliance with regulatory agencies that conduct intermittent reviews and audits to ensure contractual and regulatory compliance with Federal, State entities as well URAC. Implements and adheres to Health System and Health Plan policies and procedures for members with special health care needs (STAR Kids). Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.
Driscoll · Brownsville, TX