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Thank you for your interest in joining our team! Please review the job information below.

General Purpose of Job:

The Service Coordinator II supports maximizing the Member’s health, wellbeing, and independence. The Service Coordinator II will focus on person-centered care planning and will assess the Member’s services and support needs, assure timely community-based Long-Term Services and Supports (LTSS) to prevent, delay, or reduce the progression of chronic conditions and the need for institutionalization and to maintain the Member safely in the community. Service Coordination is a collaborative practice that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the Member’s health and human service’s needs. It is characterized by advocacy, communication and resource management and promotes quality and cost-effective interventions and outcomes. The Service Coordinator Il facilitates clinically appropriate and fiscally responsible patient care through communication with the physicians involved in the Member’s care, family, care giver, and all other members of the health care team. The Service Coordination process is holistic in its coverage of the Member’s situation and addresses medical, physical, behavioral, emotional, financial, psychosocial, and other needs, as well as that as the support system.

This Service Coordinator will be designated as the named Service Coordinator for Level 1 and/or Level 2 Members with primarily a behavioral health diagnosis not on MDCP or requiring private duty nursing services. The Service Coordinator II coordinates for any Member that requires coordination of behavioral health services.

A named Service Coordinator for a Level I Member must be a licensed social worker. A named Service Coordinator for a Level II Member may have an undergraduate or graduate degree in social work.

In order to complete the STAR Kids Screening and Assessment Instrument (SAI) modules for the Core or Personal Care Assessment Module (PCAM), the Service Coordinator must hold the credentials of MSW, LMSW, LCSW, or LBSW.

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. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by Health Plan leadership, as required.

Knowledge, Skills and Abilities:

1. Knowledge in Texas Medicaid criteria/guidelines preferred.

2. Knowledge about managed care contracts/guidelines preferred.

3. Knowledge of programs and services required to support the health and medical needs of disabled

children preferred.

4. Knowledge of various reimbursement mechanisms, including third party requirements preferred.

5. Knowledge of various utilization criteria sets (e.g. InterQual) preferred

6. Microsoft Office skills preferred.

7. Maintains utmost level of confidentiality at all times.

8. Maintains compliance with regulatory agencies that conduct intermittent reviews and audits to ensure contractual and regulatory compliance with Federal, State entities as well URAC.

9. Implements and adheres to Health System and Health Plan policies and procedures for Members with special health care needs (STAR Kids).

10. Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.

11. Behavioral Health experience preferred.

12. Pediatric experience preferred or experiencing working with children with special health care needs that will be in the STAR Kids program.

Responsibilities:

1. Function in an advisory role to the Medical Directors and Medical Management Committee in the following areas:

a. Provide evaluation of and assist in the development of quality patient care services offered by DCHP.

b. Assist in the establishment of patient care and professional staff policies and procedures of DCHP; and

c. Participate in long-range planning of services and/or programs offered by DCHP.

2. This position shall be responsible for the following aspects of the program:

a. A LMSW, LCSW, or LBSW serves as the named Service Coordinator for Level 1 Members and completes the SAI Core and PCAM modules for Members with primary behavioral health conditions.

b. A licensed (LMSW, LCSW or LBSW), unlicensed social worker (MSW or BSW) or person with