The Service Coordinator is responsible for assessing member’s functional and medical needs to collaborate with providers and coordinate and case/care management to STAR+PLUS and/or MMP Members residing in Nursing Facilities. The Service Coordinator has an overarching philosophy of providing quality care in the least restrictive environment promoting independent living, self-determination, and community integration.
- Acts as a liaison and facilitates the coordination of benefits, resources, healthcare providers, and institutions.
- Maintains a maximum weekly face to face visit schedule of twelve members with average caseload of 120.
- Attends and actively participates in Nursing Facility care plan meetings for assigned Members to collaborate with nursing facility staff to mitigate barriers to care and prevent hospitalizations.
- Works with member, member’s family, nursing facility and providers to develop a comprehensive Individualized service plan.
- Works with member to close functional, clinical, and pharmacy gaps.
- Collaborates with transition team to create a viable discharge plan for members expressing desire to return to the community through MFP process.
- Conducts a comprehensive F2F (Nursing Facility assessments) 4 times per year with Members residing in a Skilled Nursing Facility.
- Completes and files all assessments within the timelines outlined by the state.
- Uses clinical judgment to identify physical and behavioral health needs and works with the member and caregiver to establish an appropriate plan of care to ensure needs are met.
- Strong organizational and time management skills
- Must be a current Cigna or Express Scripts contractor
- Must have strong computer skills using MS office products including Word, Excel, and Outlook
- The ability to travel to members’ homes, and other locations within the service delivery area.
- Must be a Registered Nurse with a current, unrestricted Texas License
- Excellent verbal and written communication skills
- Must have reliable transportation, a valid and unrestricted driver’s license and proof of insurance.
Qualification & Experience:
- High School Diploma or GED Required.Experience working with community resource organizations preferred
- Experience with care management software applications preferred.
- Home Health Case Management experience with Medicare or Medicaid populations a plus
- Experience managing members with chronic disease processes and
Vacancy Type: Full Time
Job Functions: Health Care Provider
Job Location: Bedford, TX, US
Application Deadline: N/A