RN Service Coordinator

Company Description

Superior HealthPlan (Superior) is a managed health care company that provides health care for many Texans. Superior works with the State of Texas Health and Human Services Commission (HHSC) to bring you STAR (Medicaid), Children’s Health Insurance Program (CHIP), CHIP Perinatal Care, and STAR+PLUS in many cities and counties across Texas. Our sister company, Superior HealthPlan Network, manages the STAR Health program on a statewide basis. Below is information on the programs offered by Superior HealthPlan in partnership with the State of Texas. 

Job Description

About the Job:

· 100% in the field

· Will have a case load of about 60 members/patients  

Service Coordinators are responsible for going to members' homes and LTC facilities to assess their ADLs and living environment to determine what services are needed in order to keep them living as safely & independently as possible in the in the most cost efficient environment (trying to keep them out of the hospital in more cost efficient settings).

This is part of the Superior StarsPlus program working with the ABD (Aged, Blind & Disabeled) population.

Qualifications

RN License in the state of TX 

Strong home health experience with at least a little bit of acute care

2+ years of case management OR 2+ years of hospital clinical experience

Very computer Savvy (can they upload, save a file, scan, use Outlook/Excel etc.?)   

 *Please give Prove-It testing if they only come from Hospital Nursing!

Additional Information

Position Purpose: Collaborate with medical, behavioral, and social support staff in conducting screening and risk assessment interventions based on program guidelines 

• Identify special needs members through the completion of health screens and other resources, and advise, assist and authorize appropriate services

• Review and evaluate all requests for specialized and private care including nursing services

• Act as a clinical resource to complex medical cases and individual service plans

• Act as a liaison between members, providers and pharmacies and review and follow-up on medical referral calls

• Coordinate with the Discharge Planning teams, Case Management, and providers for difficult member placements, post hospital discharge

• Attend medical and behavioral health rounds to ensure follow up on care and service coordination on various services

• Conduct home visits to assess service needs and determine support available to members

• Oversee the development and modify service plans in conjunction with members and other interdisciplinary team members

• Serve as clinical consultant for the Service Coordination team  

· Assess members in their Nursing facilities (or homes) to determine what services and supplies are needed to keep the member living safely and as independently as possible

· Perform regular face-to-face visits with members, in compliance with State regulations

· Assessing ADL (Activities of Dialing Living) - Can this person bathe on their own, are there any structural barriers, Emergency Response precautions in place etc.)

· Perform some case management-like functions.

· Setting goals with members and tracking their progress

· Coordinating services for members by working with providers of Long Term Services and Support services, calling the member’s physician, facilitating the authorization or prior authorization process, referring to other programs the member may benefit from

· Developing and implementing care plans