What are the responsibilities and job description for the Service Coordinator - PCHP (Hybrid) position at Parkland Health?
Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.
Primary Purpose
Responsible for daily service coordination (SC) (case management and care coordination) for health plan members. Ensures a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost-effective outcomes.
Minimum Specifications
Education
Service Coordination
Primary Purpose
Responsible for daily service coordination (SC) (case management and care coordination) for health plan members. Ensures a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost-effective outcomes.
Minimum Specifications
Education
- Bachelor’s degree in nursing, social Work, or a related field required.
- For roles primarily serving members with BH conditions, master’s degree in social work, or related field preferred.
- Three (3) years of professional nursing experience in a clinical, medical, or disease-specific management setting is required. If primarily serving members with BH conditions, at least three (3) years of experience practicing behavioral health (social work, counseling, etc.) is required.
- Three (3) years of care management experience in a health plan setting or managed care organization is preferred.
- If primarily serving members with BH conditions, one (1) year of behavioral health focused care management experience is required.
- Equivalent Education and/or Experience
- May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.
- Must have and maintain current, valid RN license or temporary RN license from the Texas Board of Nursing, or valid Compact RN license. If primarily serving members with BH conditions, must have and maintain an unrestricted license such as a RN, LPC, LMFT, LBSW, LMSW or LCSW in the State of Texas.
- Certified Case Manager (CCM) credential in case management preferred.
- Proficient in medical and managed care terminology.
- Competent in the application of integrated service coordination (care management) standards.
- Familiar with auditing processes and regulatory/accreditation requirements (TDI, HHSC, NCQA, CMS).
- Proficient computer and Microsoft Office skills. Ability to learn new software programs,
- Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines. Ability to communicate complex information in understandable terms.
- Ability to manage multiple deadlines and time constraints.
- Excellent analytical and problem-solving skills.
- Ability to be flexible and work in a high growth environment.
- Excellent organizational skills and attention to detail.
- Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.
- Ability to analyze and resolve complex and conflicting information.
- Proficient in meeting NCQA standards.
- Ability to define care or disease management reporting requirements.
- Adept in use of service coordination (care management) software.
- Ability to develop and foster positive interpersonal relationships to effectively communicate and engage all levels of stakeholders.
Service Coordination
- Conducts service coordination and care management activities according to model of care, program description and policies and procedures to provide timely, quality care and services to members with physical and/or behavioral health needs.
- Evaluates member needs and available resources to facilitate the development of a care plan that will contribute to the best health outcomes for the member/family.
- Monitors care plans, member status and outcomes and provides recommendations to care plan based on identified member needs and goals, as applicable.
- Coordinates between the member and/or family/caregivers and the provider care team, as applicable, to ensure member accessibility to identified services.
- Completes case interventions according to time and completeness requirements and documents all actions and decisions.
- Maintains directory of community resources and provides resource support to members and their families/caregivers.
- Provides education to members and their families/caregivers on procedures, provider instructions, treatment options, referrals, and healthcare benefits, including behavioral health.
- Functions as liaison with member's providers.
- Integrate health literacy principles into all communication including Members and Providers.
- Support strategies that meet clinical, quality and network improvement goals.
- Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed.
- For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination.
- Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements.
- Participates in self-audits and peer reviews to ensure compliance with regulations, standards, and departmental policies and provide feedback for the Service Coordination training program.
- Promotes and supports a culturally welcoming and inclusive work environment.
- Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
- Adheres to organizational policies, procedures, and guidelines.
- Completes assigned training, self-appraisal, and annual health requirements timely.
- Adheres to hybrid work schedule requirements.
- Attends required meetings and town halls.
- Recognizes and communicates ethical and legal concerns through the established channels of communication.
- Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
- Maintains confidentiality at all times.
- Performs other work as requested that is reasonably related to the employee’s position, qualifications, and competencies.
- Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
- Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
- Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.
