Healthcare Coordinator I

LOOKING IN: Granbury, Joshua, and Burleson in TX



Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues



Determines medical necessity/ appropriateness Facilitates optimal outcomes Identifies and follow through with continuous quality/ compliance opportunities . May also include identification of aberrance's and initiation of corrective action Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy Optimize total costs Implementation and evaluation of policy based on usage and program directives Educate/empower colleagues at all levels to enable decision making at most appropriate level



Position Summary:



The Service Coordinator is responsible for conducting face to face visits in the members home utilizing comprehensive assessment tools for members enrolled in Long-Term Services and Support programs. The Service Coordinator is responsible for coordinating and collaborating care with the member/authorized representative, PCP, and any other care team participants. The Service Coordinator schedules and attends interdisciplinary meetings and advocates on the members behalf to ensure proper and safe discharge with appropriate services in place. The Service Coordinator works with the member and care team to develop a care plan and authorizes services in a cost-effective manner within the LTSS benefit. The Service Coordinator is responsible for documenting accurately and timely in the member s electronic health record. This position requires the Service Coordinator to use critical thinking skills and the ability to problem solve.



Duties:



•***This role is working remotely. This position will require travel to meet in person with members around Service Delivery Area 75% of the time.***



Utilizes critical thinking and judgment to collaborate and inform the service coordination process, in order to facilitate appropriate health care outcomes for members by providing service coordination, support and education for members through the use of service coordination tools and resources.



Contact with Members:

Through the use of service coordination tools and information/data review, conducts comprehensive assessments of referred member s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member s benefit plan, and available internal and external programs/services.

Completes face to face visits and monthly phone contact with members, utilizing various treatment modalities and interventions to achieve desired goals for members

-Applies judgment to the incorporation of strategies designed to reduce risk factors and address indicators which impact care planning and resolution of member issues while aware of member diagnosis.

Utilizes motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health.



Experience:



2 years field case management experience preferred, Bilingual preferred (Spanish)



Education:



Bachelor's degree or non licensed master level clinician required, degree being in psychology, social work, counseling, sociology, human growth and development, or early childhood education.