LTSS Service Coordinator Levl3

Houston, Texas, JOB SUMMARY The LTSS Service Coordinator Level 3 will be responsible for the non-HCBS (non-waiver) members case, as required by applicable state law and contract, contributes to the LTSS care coordination process by performing activities within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member’s case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the member’s care plan to meet the member’s needs, with the goal of optimizing member health care across the care continuum. Will perform only telephonic assessments to identify member needs and meet both state and federal guidelines. JOB SPECIFICATIONS AND CORE COMPETENCIES Essential Functions Primary Responsibilities: Assess, plan, and implement care strategies that are individualized by member and directed toward the most appropriate, lease restrictive level of care. Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services. Manage the care plan throughout the continuum of care as a single point of contact. Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members. Advocate for patients and families as needed to ensure the patient. s needs and choices are fully represented and supported by the health care team. Performs telephonic or face-to-face clinical 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.

Identifies members for high-risk complications and coordinates care in conjunction with the member and the health care team. Provide input and/or data to direct supervisor/manager related to any internal or external mandatory audit or reporting. Serve as mentor, subject matter expert or preceptor to new staff. Involved in process improvement initiatives Assist in problem solving with providers, claims or service issues. Community Health Choices Core Competencies Customer Focus Reliability and Dependability Honest and Integrity Change Management Team Work Impact/Influence + Strategic Vision People/Team Development Marginal Functions Other duties as assigned MINIMUM QUALIFICATIONS: Education/Specialized Training/Licensure: High School Diploma or GED and direct experience with the ABD/SSI population in 3 of the last 5 years required. LVN, Undergraduate or Graduate Degree in social work or a related field, Registered Nurse, licensed social worker and/or clinical degree preferred. Work Experience (Years and Area):Required: 4+ years of experience working within the community health setting in a health care role 1+ years of experience working with MS Word, Excel, and Outlook Experience in long-term care, home health, hospice, public health or assisted living Preferred: 2+ years of case management experience in a managed care setting 1+ years of experience working with Medicaid Waiver services Experience with arranging community resources Field based work experience Experience with electronic charting Background in managing populations with complex medical or behavioral needs Management Experience (Years and Area): N/A Software Proficiencies: Microsoft Office, Clinical Documentation Platforms.

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