Service Coordinator 2 - Texas Star KidsPrimary Location: Dallas, TX
Additional Locations: TX-Dallas Apply
This position will be working from home but will require routine travel in the Dallas service area, 80-90% of the time. Some travel to the Dallas office, support location, may also be required.
The Service Coordinator 2, (Case Management Coordinator) is a field based position that conducts comprehensive telephonic and face to face evaluations. Candidates may reside in any of these or adjacent counties: Collin, Dallas, Ellis, Hurt, Kaufman, Navarro, and Rockwall. Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. 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.
71036Fundamental 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.
Appropriateness and Quality of Care: - Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes. - Identifies and escalates quality of care issues through established channels. -Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs. - Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote 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 base management and eligibility. Assessment includes the member's level of work capacity and related restrictions/limitations. Monitoring, Evaluation and Documentation of Care: - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
- Minimum of 1 year previous service coordination or case management experience and experience with pediatric clients is required; integrated model experience is preferred
- 2+ years experience in behavioral health, social services or appropriate related field equivalent to program focus preferred
- Bilingual skills preferred (Spanish)
- Managed Care experience preferred
- Graduate degree in social work or related human services field (i.e., psychology, counseling, marriage and family therapy, etc.), a non-licensed master level clinician is required.
- 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
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