Service Coord III - LVN Valley

Essential Duties and Responsibilities

• Function in an advisory role to the Medical Directors and Medical Management Committee in the following areas:
  • Provide evaluation of and assist in the development of quality patient care services offered by DCHP;
  • Aid in the establishment of patient care and professional staff policies and procedures of DCHP;
  • Participate in long-range planning of services and/or programs offered by DCHP.
• Provides service coordination within the Health Homes and links Members to assigned service coordinators as required;
  • 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.
  • Identify, select, obtain, coordinate, and use services and supports to enhance the member’s wellbeing, independence, integration into the community, and potential for supportive employment.
  • Enroll member in disease management and monitor and document progress.
• Answers Service Coordination Integrated Pod (SCIP) phone calls from the members who call the SCIP and handle appropriately;
  • Enter LTSS authorizations into the system per the direction of the Service Coordinators in the SCIP.
  • Communicate with management regarding status of current workload and turn-around time discrepancies as necessary.
• Produce status reports on a regular basis to track members in STAR Kids;
  • Ensure thorough knowledge of the STAR Kids contract and meet all Service Coordination contract requirements.
• Participate in health plan’s performance improvement activities;
  • Participate in health plan committees as appropriate and on request.
• Accept other assignments from management as requested and comply 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 Associate’s 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.
• At least a 4-year college degree and current, active, and unrestricted licensure as a Licensed Vocation Nurse (LVN).
• Previous service coordination or case management experience.
• Minimum 3 years of clinical experience (pediatric preferred) or 1 year experience in managed care.
• Previous experience with the State of Texas STAR+PLUS program or similar programs dealing with SSI and disabled children preferred.
• Knowledge of the Medicare/Medicaid dual population preferred.