STAR+PLUS LTSS Srvc Coor 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 Star+Plus (LTSS) Service Coordinator (SC) Level 2 will work directly with customers, their families and/or advocates to ensure that the member has access to Community Health Choice (CHC) resources offered through the Long-Term Support and Services (LTSS) Program. The SC works collaboratively with the RN case manager to support, promote, and facilitate engagement in the LTSS Case Management Program. The SC will work as a bridge between the customer, the health plan, and the Community based Organizations to create a seamless and positive experience to fulfill their unmet care needs. The SC will build individual capacity by increasing health and wellness self-management skills and sufficiency through a series of activities such as outreach, education, encouragement, social supports, and advocacy.
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 patient's needs and choices are fully represented and supported by the health care team.
Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health, social services and long-term services and supports.
Identifies members for high-risk complications and coordinates care in conjunction with the member and the health care team
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.
Other duties as assigned
Education/Specialized Training/Licensure: HS Diploma or GED with 4 years relevant experience; OR HS Diploma with qualified IDD certification; OR Bachelor's in social work or a related field; OR LVN, RN, NP PA required.
Undergraduate or graduate degree in social work or a related field; OR be an LVN, LSW, LCSW or LMSW preferred.
Work Experience (Years and Area):
3 years' experience with the ABD/SSI population in three of the last five years
1 year of case management experience in a managed care setting.
1+ years' experience working with Medicaid Waiver services,
Experience with arranging community resources, Field based work experience,
Experience with electronic charting 1 year of case management experience in a managed care setting.
Software Proficiencies: Microsoft Office, Clinical Documentation Platforms