| Service Coordinator Other - HI/Waipahu |
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Coordinates, monitors and ensures that appropriate and timely primary, acute and long-term care services are provided to members across the continuum of care excluding within nursing facilities. Assists with coordinating services with federal and state programs, and other community services to the member. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes. Works with the Manager of Service Coordination to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member. Receives and reviews authorizations for services from providers and members via phone, fax or written request. Assists RN level Service Coordinators with aspects of their case load and administrative duties when needed. Essential Functions: - Conducts face-to-face Health and Functional Assessments (HFA) for all members on an annual or more frequent basis (as applicable).
- Develops a Care Plan for each member, in conjunction with the PCP and member, based upon the outcomes of the HFA.
- Coordinates a team of decision makers including the PCP, other providers as appropriate, the member, and others as determined by the member including family members, caregivers, and significant others to become part of a member's Interdisciplinary Care Team (ICT).
- Coordinates services with other providers such as Medicare, DOH Programs, Medicare Advantage Plans, specialty providers, Zero-to-Three, HealthStart, mental health, and Developmentally Disabled/Mentally Retarded (DD/MR) providers at DOH.
- Maintains HIPAA standards and confidentiality of protected health information; and reports critical incidents and information regarding quality of care issues.
- Utilizes compiled data received from member encounters to assure that the services being provided meet the member's needs.
- Facilitates member and provider authorization and access to services.
- Seeks to resolve any concerns about care delivery or providers.
- Monitoring of the member self-direction delivery process
- Monitors progress with Early and Periodic Screening, Diagnosis and Treatment (EPSDT) requirements.
- Refers members who with suspected severe emotional, behavioral and/or mental illness for evaluation;
- Manages a caseload that does not exceed 1880 hours annually, based on case intensity and acuity.
- Acts as liaison and member advocate between the member/family, physician and facilities/agencies.
- Maintains accurate records of service coordination activities in the system using clinical guidelines.
- Ensures compliance with all state and federal regulations and guidelines.
- Perform other duties as assigned.
- Receives general supervision from the Manager of Service Coordination.
- Participates in quarterly audits or more frequent as necessary.
- Participates monthly with other Service Coordination staff in meetings.
- Participates in initial orientation and in ongoing training activities, including training on 'Ohana's Enterprise Medical Management Application (EMMA) System.
- Requires considerably discretion and independent judgment when applying clinical criteria in determining medical necessity, case management and service needs, and other matters of clinical significance.
- Performs complex administrative tasks closely guided by policy and past clinical practice.
- Decisions within the scope of the job, consistent with Plan/department policy and procedure.
Education/Experience:
High School diploma or GED equivalent
Minimum of 1 year of long-term care or other relevant health care experience. 2-4 years desired.
Licensed Practical Nurse (LPN) in the State of Hawaii Or A Bachelor's Degree in Psychology/Social Work
Managed care experience preferred
Communication and Numeric Skills:
Advanced ability to communicate on any level required to meet the demands of the position
Ability to create, review and interpret treatment plans
Bi-lingual in English and any of the following languages preferred: Ilocano, Tagalog, Mandarin Chinese, or Korean a plus
Computer Skills:
Knowledge of Micro Soft Office including Excel, Word and Outlook
Knowledge data entry, documentation and report generation in any clinical system a plus
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- Industry:
Healthcare - Health Services
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- Manages Others:
Not Specified
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- Req'd Education:
Not Specified
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- Req'd Experience:
Not Specified
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- Relocation Covered:
Not Specified
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