Location: This is a field position and the candidate should reside in Dallas or Houston, TX.
The LTSS Service Coordinator - Clinician working under the direction/supervision of an RN, with overall responsibility for the member's case, as required by applicable state law and contract, contributes to the LTSS care coordination process by performing activities within the scope of licensure including, for example, assisting the responsible RN with telephonic 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.
How you will make an impact:
Identifies members for high risk complications.
Obtains clinical data.
Identifies members that would benefit from an alternative level of care or other waiver programs.
Verifies and interprets information, conducts additional assessments, as necessary, and develops, monitors, evaluates, and revises the member's care plan to meet the member's needs.
Participates in coordinating care for members with chronic illnesses, co-morbidities, and/or disabilities, and in conjunction with the RN, member and the health care team, to ensure cost effective and efficient utilization of health benefits.
Decision making skills will be based upon the current needs of the member and require an understanding of disease processes and terminology and the application of clinical guidelines but do not require nursing judgment.
Minimum Requirements:
Requires an LPN/LVN, LSW, LCSW, or LMSW or license other than RN in accordance with applicable state law and Nursing Diploma or AS in Nursing or a related field and minimum of 2 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator or similar role; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted LPN/LVN, LSW, LCSW, LMSW or license other than RN (as allowed by state law) in applicable state(s) required.
May require state-specified certification based on state law and/or contract.
Preferred Skills, Knowledge, and Experience:
Previous experience with Utilization Management preferred.
Computer experience and experience using Microsoft Office Suite to include Outlook, Word, and Excel.
Travels to worksite and other locations as necessary.
