Service Coordinator RN

Community First Health Plans; San Antonio (TX); On-site; USD 70,000 - 80,000; Full time

Job summary

Community First Health Plans is seeking an RN Service Coordinator to oversee the Long Term Services and Supports (LTSS) for Members. The role involves conducting assessments, developing care plans, and coordinating services to enhance Members' well-being and independence.

Candidates must have a current Texas nursing license and preferably a BSN with four years of clinical experience. Bilingual candidates in English and Spanish are encouraged to apply. This position focuses on meeting the needs of vulnerable populations.

Qualifications

• Graduated from an accredited school of professional nursing or social work.
• Four years of clinical experience preferred, including case management or managed care.
• Knowledge of Medicare and Medicaid HMO standards.

Responsibilities

• Contribute to the LTSS service coordination process.
• Conduct holistic assessments of Members' dynamics and needs.
• Coordinate services to meet Members' physical, behavioral, functional, and psychosocial needs.

Skills

Clinical experience

Service coordination

Bilingual (English/Spanish)

Education

Graduation from accredited nursing or social work school

Bachelor of Science in Nursing (BSN)

Job description

POSITION SUMMARY/RESPONSIBILITIES

The RN Service Coordinator-RN (RN-SC) contributes to the Long Term Services and Supports (LTSS) service coordination process by performing activities within the scope of licensure; provides supervision and direction to staff participating in Member’s cases following applicable state law and contract; develops, monitors, evaluates, and revises the Members’ care plans to meet Member’s needs, to optimize health care across the care continuum to enhance the Member's well‑being, independence, integration in the community, and potential for productivity. The RN-SC conducts a holistic assessment of the Member's dynamics, needs, and preferences while providing education and health‑related information to the Member, the Member’s Legal Authorized Representative (LAR), and the Member’s Support Network. Responsible for the coordination of STAR+PLUS Members' covered and non‑capitated services, including acute and LTSS, while meeting the Member's physical, behavioral, functional, and psychosocial needs. Complies with policies, procedures, and protocols for establishing and maintaining good working relationships with co-workers, employees, patients, and guests.

EDUCATION/EXPERIENCE

Graduation from an accredited school of professional nursing or social work is required. BSN is preferred. Four (4) recent years of clinical experience preferred, which may include service coordination, case management, quality management, or managed care experience. Working knowledge of HMO standards, LTSS, and NCQA standards is preferred. Knowledge of Medicare and Medicaid HMO experience is preferred. Experience in meeting the needs of vulnerable populations who have chronic or complex conditions is required. Bilingual, English/Spanish, is preferred.

LICENSURE / CERTIFICATION

A current, unrestricted license to practice professional nursing issued by the State of Texas is required.