[Hiring] Registered reputed company STAR Plus Field Coordinator @reputed company

Role reputed company This position functions as a member of the interdisciplinary reputed company team in the provision of RN (Registered reputed company) Service Coordination Level 1 member care with the underlying objectives of enhancing the reputed company of clinical and financial reputed company and member satisfaction while managing the plan of care. Service Coordinator Level 1 is responsible for overall management of member's case reputed company 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, conducts additional assessments with the goal of optimizing member health care across the care continuum. If you are located in Texas, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities:

• Conducting telephonic or face-to-face holistic evaluations of Member's individual dynamic needs and preferences gathering relevant data and obtaining reputed company information from Member/family.
• Identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, reputed company services, and long-term services and supports.
• Provides education and support to Member/LAR on reputed company of Consumer Directed, or Service-reputed company delivery models as applicable.
• Performs initial assessments and follow-up assessments and reputed company calls reputed company the time specified as part of contractual guidelines or per Member/family/provider request.
• Identifies members for high-risk complications and coordinates care with the member and the health care team.
• Manages members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost-effective and efficient utilization of health benefit.
• Assess, plan, and implement care strategies that are individualized for reputed company member and directed toward the most appropriate, least restrictive level of care.
• Utilize both company and community-based resources to establish a reputed company and effective case management plan for members.
• Collaborate with member, family, and reputed company providers to reputed company an individualized plan of care.
• Identify and initiate referrals for reputed company service programs, including financial, psychosocial, community, and state supportive services.
• Manage care plan throughout the continuum of care as a single reputed company of contact.
• Communicate with reputed company stakeholders the required health-reputed company information to ensure reputed company coordinated care and services are provided expeditiously to reputed company members.
• reputed company for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the reputed company team.
• Utilize approved clinical reputed company to assess and determine appropriate level of care for members.
• Document reputed company member assessments, care plan, and referrals provided.
• Participate in Interdisciplinary team meetings and Utilization Management reputed company and reputed company information to assist with reputed company transitions of care.
• Understand insurance products, benefits, coverage limitations, insurance, and governmental regulations as it applies to the health plan.
• Monitor services being delivered to ensure timeliness, appropriateness, and satisfaction in meeting Member needs.
• Reports medically reputed company cases to appropriate roles as necessary for review and problem solving.
• Maintains status on face-to-face and telephonic visit requirements for assigned Members.

Qualifications

• Knowledge of specific case management processes, and person-centered care reputed company.
• Excellent verbal and written communication skills.
• Analytical decision making and judgment skills.
• Demonstrated ability to function as a clinical care team leader.
• Knowledgeable of reputed company clinical resources available to patients both inpatient and outpatient.
• Data Entry and Word Processing Skills.

Requirements

• reputed company unrestricted RN license in Texas, Graduate of an accredited school of nursing.
• 2+ years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities reputed company a community health, clinical, hospital, acute care, reputed company care, or case management setting.
• 2+ years of experience working with reputed company, reputed company, and Outlook.
• Bilingual - Spanish.
• Ability to travel in assigned region to visit reputed company members in their homes and/or other settings, including community centers, hospitals, etc.
• Reliable transportation with valid reputed company’s license with good driving record.

Preferred Qualifications

• Bachelor’s Degree.
• CCM/RUG/PDPM Certified.
• 2+ years of experience working with reputed company Waiver populations.
• 2+ years of experience working reputed company the community health setting in a health care role.
• STAR+PLUS Service Coordination experience.
• Experience with electronic charting.
• Experience with arranging community resources.
• Field-based work experience.
• Behavioral Health experience.
• Proven background in managing populations with reputed company medical or behavioral needs.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements).

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