Service Coord - RN Valley

Where Compassion Meets Innovation and Technology and Our Employees Are Family

Thank you for your interest in joining our team! Please review the job information below.

General Purpose of Job

The service coordination program supports maximizing the member's health, wellbeing, and independence. The RN will focus on person-centered care planning and will assess all the member's services and support needs, all assure timely community-based Long Term Services and Supports (LTSS) to prevent, delay, or reduce the progression of chronic conditions and the need for institutionalization and to maintain the member safely in the community. Service coordination is a collaborative practice that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the member's health and human service's needs. It is characterized by advocacy, communication and resource management and promotes quality and cost-effective interventions and outcomes. The service coordinator facilitates clinically appropriate and fiscally responsible patient care through communication with the physicians involved in the members care, family, care giver, and all other members of the health care team. The service coordination process is holistic in its coverage of the member's situation and addresses medical, physical, behavioral, emotional, financial, psychosocial, and other needs, as well as that as the support system. These nurses will also work with the Health Homes and high volume primary care providers to assist with coordination of STAR Kids member's needs. This Service Coordinator will be responsible for all Level I and Level II members. The Service Coordinator is responsible for the acute care authorizations, concurrent review, and collaborating with each member's Service Coordination Integration Pod (SCIP) for discharge planning, and assists with disease management for the level 1, 2 and 3 members.

The Service Coordinator is responsible for the coordination and efficient utilization of health care resources for the provision of quality care for all patients throughout the continuum of care. The LTSS Case Manager :

• Facilitates clinically appropriate and fiscally responsible patient care through communication with the providers and health plan medical directors, and all other members of the health care and health plan team.
• Assesses and identifies the patient's clinical findings and determines, in conjunction with the Physician Advisor / Health Plan Administration, established benefits, protocols, pathways, and evidence based medicine tools, the health care services and level of care appropriate for the member,
• Reviews services either prospectively, concurrently, or retrospectively,
• Communicates with providers of care / services to ensure appropriate levels of care and coordination of LTSS for applicable members

Essential Duties and Responsibilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by Health Plan leadership, as required.

Education and / or Experience

This position can be filled as an RN, Nurse Practitioner, or Physician's Assistant.

Licenses, Certifications, Registrations