Service Coordinator III Valley

General Purpose

The Service Coordinator III program supports maximizing the member’s health, well‑being, and independence. The role focuses on person‑centered care coordination, reviewing members’ services and support needs in collaboration with the assigned service coordinator to assure timely community‑based Long‑Term Services and Supports (LTSS). This helps prevent, delay, or reduce the progression of chronic conditions and the need for institutionalization, maintaining members safely in the community. Service coordination is a collaborative practice that assesses, plans, implements, coordinates, monitors, and evaluates options and services required to meet members’ health and human service needs. It is characterized by advocacy, communication, and resource management, promoting quality and cost‑effective interventions and outcomes. The Service Coordinator III facilitates clinically appropriate and fiscally responsible patient care coordination through communication with physician offices, families, caregivers, and the broader health‑care team, addressing medical, physical, behavioral, emotional, financial, psychosocial, and other needs.

Responsibilities

• Provide administrative support for care coordination to the assigned Service Coordinator RN’s and SW’s.
• Conduct outreach and care coordination to Level 3 STAR Kids members as warranted.
• Coordinate care and efficient utilization of health‑care resources for STAR Kids patients through communication with physicians, social workers, nurses, and other multidisciplinary team members.
• Assist members in identifying, selecting, obtaining, coordinating, and using services and supports to enhance wellbeing, independence, community integration, and potential for supportive employment.
• Refer members to the disease management team as appropriate.
• Answer Service Coordination Pod ACD phone calls and handle them appropriately.
• Communicate workload status and turn‑around time discrepancies to management; obtain manager approval for any workload redistribution.
• Produce regular status reports tracking STAR Kids members to support the POD manager and Service Coordinators.
• Maintain thorough knowledge of the STAR Kids contract and meet all Service Coordination contract requirements.
• Participate in health‑plan performance improvement activities and committees as requested.
• Accept additional assignments from management and adhere to basic management principles of delegation.

Knowledge, Skills, and Abilities

• Knowledge of Texas Medicaid criteria/guidelines (preferred).
• Understanding of managed care contracts/guidelines (preferred).
• Familiarity with programs and services supporting the health and medical needs of disabled children (preferred).
• Awareness of various reimbursement mechanisms, including third‑party requirements (preferred).
• Proficiency with Microsoft Office (preferred).
• Maintain utmost confidentiality at all times.
• Ensure compliance with regulatory agencies, intermittent reviews, and audits for contractual and regulatory compliance with Federal, State, and URAC standards.
• Implement and adhere to Health System and Health Plan policies and procedures for medically complex members (STAR Kids).
• Demonstrate ethical business practices and personal actions that align with corporate compliance and integrity guidelines.

Education and Experience

• High school diploma or equivalent (required).
• Associate’s degree (2‑year college) preferred.
• Experience as a case‑management support technician, customer service representative in a medical office or health plan, utilization review technician, or LTSS coordinator with DADS or DSHS (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 for contractual contact to Level 3 members).
• Four‑year college degree and/or active, unrestricted Licensed Vocational Nurse (LVN) licensure (preferred).
• Prior service coordination or case‑management experience (preferred).
• Minimum three years of clinical experience (pediatric preferred) or one year of experience in managed care.
• Experience with the Texas STAR+PLUS program or similar programs dealing with SSI and disabled children (preferred).
• Knowledge of the Medicare/Medicaid dual population (preferred).