STAR+PLUS LTSS Service Coordinator Levl2
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
Skills / Requirements
The LTSS Service Coordinator Level 2 is responsible for overall management of non-HCBS (non-waiver) 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. Will perform a mix of face-to-face and telephonic assessments as mandated by state and federal regulations.
JOB SPECIFICATIONS AND CORE COMPETENCIES
- Assess, plan, and implement care strategies that are individualized by member and directed toward the most appropriate, lease restrictive level of care.
- Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services.
- Manage the care plan throughout the continuum of care as a single point of contact.
- Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members.
- Advocate for patients and families as needed to ensure the patients needs and choices are fully represented and supported by the health care team.
- Perform telephonic and/or face-to-face clinical assessments for the identification, evaluation, coordination and management of members needs, including physical health, behavioral health, social services and long-term services and supports.
- Identify members for high-risk complications and coordinates care in conjunction with the member and the health care team.
- Manage members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.
- Assists in meeting member needs by referring members to internal and external resources.
- Provide follow up with internal and external resources, providers, and state programs.
- Expect to spend about 50% of your time in the field visiting our members in their homes or in long-term care facilities. Youll need to be flexible, adaptable and, above all, patient in all types of situations.
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.
Community Health Choices Core Competencies
Reliability and Dependability
Honest and Integrity
Impact/Influence + Strategic Vision
Other duties as assigned.
- Education/Specialized Training/Licensure: Requires a minimum of LVN, qualified IDD professional, or have an undergraduate or graduate degree in social work or a related field.
- Registered Nurse, Nurse Practitioner, Licensed Social Worker, Physician Assistant preferred.
Work Experience (Years and Area):Required:
- 4+ years of experience working within the community health setting in a health care role required.
- 1+ years of experience working with MS Word, Excel, and Outlook
- Experience in long-term care, home health, hospice, public health or assisted living
- Ability to travel in assigned region to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, or provider¿s offices.
- 1+ years of experience working with Medicaid Waiver services.
- Experience with arranging community resources
- Field based work experience
- Experience with electronic charting
- Background in managing populations with complex medical or behavioral needs.
- 3-4 years working as a Service Coordinator, Case Manager, or similar role in a managed care setting
Management Experience (Years and Area): N/A
- Software Proficiencies:
- Microsoft Office
- Clinical Documentation Platforms
- Reliable transportation with valid drivers license with good driving record reqired.