Senior Service Coordinator III — Care Coordination Leader

Driscoll Health Plan; Corpus Christi (TX); On-site; USD 43,000 - 65,000; Full time

Job summary

Driscoll Health Plan is seeking a Service Coordinator III to support person-centered care coordination for LTSS needs in the Texas STAR Kids program. Focus on collaboration with RN and SW teammates, physicians, families, and the health care team to ensure timely, community-based services and prevent institutionalization.

The role emphasizes advocacy, resource management, and holistic assessment of medical, behavioral, emotional, financial, and social needs.

Qualifications

• Knowledge of Texas Medicaid criteria/guidelines preferred.
• Knowledge of managed care contracts/guidelines preferred.
• Knowledge of programs and services required to support the health and medical needs of disabled children preferred.
• Knowledge of various reimbursement mechanisms, including third party requirements preferred.
• Microsoft Office skills preferred.
• Maintains utmost level of confidentiality at all times.
• Maintains compliance with regulatory agencies that conduct intermittent reviews and audits to ensure contractual and regulatory compliance with Federal, State entities as well URAC.
• Implements and adheres to Health System and Health Plan policies and procedures for the medically complex members (STAR Kids).
• Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.

Responsibilities

• Function in an advisory role to the Medical Directors and Medical Management Committee in quality patient care services development and policy support.
• Provide administrative support for care coordination to the assigned Service Coordinator RN's and SW's; perform outreach as warranted.
• Coordinate care and efficient utilization of health care resources for STAR Kids members with the health care team.
• Identify, select, obtain, coordinate, and use services and supports to enhance member wellbeing, independence, and integration into the community.

Skills

Texas Medicaid criteria/guidelines

Managed care contracts/guidelines

Programs and services for disabled and

Reimbursement mechanisms

Microsoft Office

Confidentiality

Regulatory compliance (URAC etc.)

Ethical conduct

Job description

Driscoll Health Plan is seeking a Service Coordinator III to support person-centered care coordination for LTSS needs in the Texas STAR Kids program. Focus on collaboration with RN and SW teammates, physicians, families, and the health care team to ensure timely, community-based services and prevent institutionalization.

The role emphasizes advocacy, resource management, and holistic assessment of medical, behavioral, emotional, financial, and social needs.