Care Coordination Specialist

2 weeks ago


San Antonio, Texas, United States University Health System- San Antonio Full time

POSITION SUMMARY/RESPONSIBILITIES
The RN Service Coordinator (RN-SC) plays a vital role in the Long Term Services and Supports (LTSS) coordination process by executing tasks within the bounds of licensure. This position entails overseeing and guiding staff involved in the care of Members, adhering to relevant state regulations and contractual obligations. The RN-SC is responsible for formulating, assessing, and updating the care plans tailored to meet the individual needs of Members, aiming to enhance their overall health and well-being, foster independence, and promote community integration.

The RN-SC performs comprehensive evaluations of the Members' circumstances, requirements, and preferences, while also providing essential education and health-related insights to the Members, their Legal Authorized Representatives (LAR), and their Support Networks.

This role encompasses the coordination of both covered and non-capitated services for STAR+PLUS Members, addressing their physical, behavioral, functional, and psychosocial needs.

EDUCATION/EXPERIENCE
A degree from an accredited nursing or social work program is mandatory, with a Bachelor of Science in Nursing (BSN) being preferred. A minimum of four (4) years of recent clinical experience is desirable, which may include roles in service coordination, case management, quality assurance, or managed care. Familiarity with HMO standards, LTSS, and NCQA guidelines is advantageous. Experience in catering to the needs of vulnerable populations with chronic or complex health conditions is essential. Bilingual proficiency in English and Spanish is preferred.

LICENSURE/CERTIFICATION
A current, unrestricted nursing license issued by the State of Texas is required. RUG Certification is also necessary and must be acquired within 30 days of employment for all RN candidates.



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