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Corporate Functions & Operations WellCare - Clinical Support Careers

Service Coordinator Job

Full Job Title: Service Coordinator - HI Kapolei

Job Number: 1702010

Location: Oahu, HI

Date Posted: 7-13-2017

Dept Health Services
Reports to Manager Service Coordination
Location Kapolei
Level L8
Coordinates, monitors and ensures that appropriate and timely primary, acute and long-term care services are provided to members across the continuum of care. Assists in 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. Office based associates may assist field based Service Coordinators with aspects of their case load and administrative duties when needed. LPN's also perform nursing Skills Check List for HCBS providers under the Self-Direction program and provide clinical guidance and training to non-licensed Service Coordinators.
Essential Functions:
  • Position may be office based or field based depending on needs of the membership and/or management recommendation.
  • 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 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).
  • Interacts with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and current status and to assess the options for care including use of benefits and community resources to update the Care Plan.
  • Coordinates community resources with emphasis on the development of natural support system and coordinates benefits, regulations, laws and public entitlement programs.
  • Provides counseling on options regarding institutional placement and HCBS alternatives.
  • Coordinates services with other providers such as Medicare, DOH Programs, Medicare Advantage Plans, specialty providers, Zero-to-Three, Healthy Start, 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 electronic record 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.
  • Monitors member self-direction delivery process
  • Monitors progress with Early and Periodic Screening, Diagnosis and Treatment (EPSDT) requirements.
  • Refers members 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.
  • Performs other duties as assigned.
Duties performed only if LPN:
  1. Trains and/or refers to an agency provider for training Self-Direct HCBS PA 2 providers; Assures the competency of each provider using the'Ohana Skills Check List.
  2. Refers RN delegated skills providers to an agency provider for training.
· High School diploma or GED equivalent minimum.
· Minimum of 2 years of long-term care or other relevant health care experience. 3-4 years desired.
· A Bachelor's Degree in Psychology/Social Work or other relevant discipline desired.
· Experience in working with special populations, such as HIV/AIDS, developmental disabilities, medically fragile children, geriatrics, persons with neurotrauma, and younger adults with physical disabilities desired.
· Managed care experience preferred.
· Licensure in the state of Hawaii as a licensed practical nurse (LPN) desired.
Special Skills (e.g. 2nd language):
· 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.
Technical Skills/Requirements:
· Knowledge of Microsoft Office including Excel, Word and Outlook.
· Knowledge of data entry, documentation and report generation in any clinical system a plus.
Other Position Requirements:
· Uses discretion and independent judgment when applying criteria in determining case management and service needs, and other matters of clinical significance.
· Collaborates with other licensed Service Coordinators on cases that require more intense clinical assessment.
· Performs complex administrative tasks closely guided by policy and past clinical practice.
· Works with organization RNs to complete 1147 level of care assessments.
· Makes decisions within the scope of the job, consistent with Plan/department policy and procedure.
· Assists in evaluating process improvements.
· Works independently, handles multiple assignments and prioritizes workload.
· Seeks help in managing workload, when appropriate.
· Demonstrates teamwork and negotiation skills.
· Communicates effectively in person and by phone
· Travels to member's location of residence as needed and uses a laptop computer to complete the HFA, initial care plan and documentation.

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Last Updated On: 12/9/2015