Case Manager, Service Coordinator LMSW - STAR Kids - Health Plan (Multiple Locations)

 
Position: Case Manager, Service Coordinator LMSW - STAR Kids - Health Plan (Multiple Locations)

Talent Area: Social Worker

Shift: 8a - 5p

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Summary:

We are searching for a Service Coordinator Advanced Social Worker - someone who works well in a fast-paced primary care setting. In this position, you’ll function as a member of the interdisciplinary healthcare team in the provision of Level I (and higher) patient care with the underlying objectives of enhancing the quality of clinical and financial outcomes and patient satisfaction while managing the plan of care. You’ll also pro-actively communicate with members of the healthcare team to ensure appropriate medical necessity for patients in beds and communicate with Payers and patient/family/healthcare team regarding payer information as necessary. Additionally, you’ll ensure that care moves through the episode of care in a timely and efficient manner.

 

Think you’ve got what it takes?



Responsibilities :

  • Completes a comprehensive problem identification analysis of Level I (and higher) patients to identify opportunities for intervention that are appropriate and realistic for the patient/family’s psycho-social, cultural, spiritual, and physical plan of care
  • Conduct holistic evaluations of Member's individual dynamic needs and preferences gathering relevant data and obtaining further information by interviewing Member/family and performing careful evaluation of psychosocial, environmental, cultural, health access and medical variables
  • Identifies actual and potential problems in services and treatments and discusses with the multidisciplinary team to identify solutions to barriers
  • Coordinates, facilitates and monitors the plan of care for Level I (and higher) patients throughout the episode and continuum of care to achieve the optimal clinical and financial outcomes
  • Oversees discharge planning and facilitates safe transitions to community settings
  • Plans and executes interdisciplinary and patient/family conferences as necessary to formulate and communicate the plan of care
  • Serves as a liaison between members of the interdisciplinary care team, community providers, payer sources, and patient/family to ensure safe and effective plans and smooth transitions between internal and external levels of care
  • Maintains professional relationship with payer representatives and assists in resolving any utilization issues that arise
  • Advocates for Member's care needs within the healthcare delivery system and associated services
  • Effectively and efficiently oversees the plan of care to optimally assure clinical and financial outcomes
  • Assures timely performance of utilization management processes to maintain compliance with Federal, State, and Managed Care contract regulations
  • Within the social work scope of practice, the care manager continuously assesses self-knowledge and competencies to assure job performance
  • Maintains current education and training to adeptly identify the Member's physical, behavioral, functional, and psychosocial needs


Qualifications:

    • Master’s Degree in Social Work
    • Certified Advanced Social Worker Case Manager (C-ASWCM) issued by the National Association of Social Workers preferred
    • Licensed Master Social Worker (LMSW) issued by the Texas Board of Social Work Examiners or Licensed Clinical Social Worker (LCSW) issued by the Texas Board of Social Work Examiners 
    • Three (3) years of social work experience
    • Preferred experience in pediatrics working with children with special healthcare needs or working with a special needs population
    • Certified Case Manager (CCM), certificate of completion of Adult and Pediatric Integrated Case Management preferred
    • Comparable experience in social work experience, home health, managed care, case management; experience working with children’s with disabilities/special needs 
    • Experience working with insurance companies is also a plus
    • Current U.S. driver’s license is required for all new hires/transfers effective 08/01/16.
    • Current personal motor vehicle insurance is required for all new hires/transfers effective 08/01/16.


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