Service Coordinator III

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.

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 the medically complex members (STAR Kids).
• Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.

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 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 STAR+PLUS program or similar programs dealing with SSI and disabled children preferred.
• Knowledge of the Medicare/Medicaid dual population preferred.