Service Coordinator 1- Behavioral Health Texas STAR KidsPrimary Location: Dallas, TX
Additional Locations: TX-Dallas Apply
The Service Coordinator 1, (Clinical Case Manager BH) is a field-based position responsible for conducting face to face assessments. Candidates may reside in any of these or adjacent counties: Collin, Dallas, Ellis, Hurt, Kaufman, Navarro, and Rockwall. Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. This position requires routine travel in the Dallas service area, 80-90% of the time. Some travel to the Dallas office, support location, may also be required. Use of personal vehicle when traveling in the field; must have active and valid TX driver's license, reliable transportation and vehicle insurance. Business mileage is eligible for reimbursement, in accordance with travel policy guidelines.
71035Fundamental Components: Assessment of Members:
- Through the use of clinical tools and information/data review, conducts comprehensive face to face assessments of referred member’s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member’s benefit plans and available internal and external programs/services.
- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.
- Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
- Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
- Actively engage with providers and members during key transitions of care.
Enhancement of Medical Appropriateness and Quality of Care:
- Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits
- Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes
- Identifies and escalates quality of care issues through established channels
- Ability to speak to medical and behavioral health professionals to influence appropriate member care.
- Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Helps member actively and knowledgeably participate with their provider in healthcare decision-making
- Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
- Reviews prior claims to address potential impact on current case management and eligibility.
- Assessment includes the member's level of work capacity and related restrictions/limitations.
Monitoring, Evaluation and Documentation of Care:
- In collaboration with the member and their care team develops and monitors established person-centered plans of care to meet the member’s goals
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Background Experience:
- Minimum of 1 year previous service coordination or case management experience and experience with pediatric clients is required; integrated model experience is preferred
- 3+ years of direct clinical practice experience post-masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility required
- Bilingual preferred (Spanish)
- Crisis intervention skills preferred
- Managed care/utilization review experience preferred
- Minimum of a Master's degree in Behavioral/Mental Health or related field
- Unencumbered Behavioral Health clinical license in the state where they work required (i.e., LCSW, LPC, LMSW, etc.)
- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel. Strong keyboard and mouse skills required.
- Working knowledge of care management principles preferred
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