RN Manager Service Coor Valley

Driscoll Children's Hospital Laredo, TX, US

Where compassion meets innovation and technology and our employees are family.

Thank you for your interest in joining our team! Please review the job information below.

General Purpose of Job:

The Service Coordination Manager is responsible for daily operations of the STAR Kids program assuring the program is performed according to the State contract. The Service Coordination Manager is responsible for training and evaluation of service coordination staff as well as dissemination of information to the staff related to benefits, operations and policy. The Manager participates in ongoing development of policies and procedures for STAR Kids. The Manager enforces quality and performance standards, monitors service coordination performance and presents findings to the Director on an ongoing basis. The Manager provides leadership to facilitate clinically appropriate and fiscally responsible patient care through communication with other members of the health care team.

Essential Duties and Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required.

Maintains utmost level of confidentiality at all times.
Maintain compliance with regulatory agencies that conduct intermittent reviews and audits to ensure contractual and regulatory compliance with Federal, State entities as well URAC.
Implement and adhere to Health System and Health Plan policies and procedures for members with special health care needs (STAR Kids).
Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.
Assures service coordination staff follows and meets requirements of the service coordination program, roles and responsibilities including all assessments and contractual requirements. The above statements should be included on all job descriptions.
List the job's essential or most important functions and responsibilities. Include all important aspects of the job -- whether performed daily, weekly, monthly, or annually; and any that occur at irregular intervals. Standard functions listed below should be included on all job descriptions.
Holds weekly case conferences and SCIP meetings.
Participates in policy and procedure development.
Collaborates with trainer to assure all staff are trained and ready to assume job responsibilities and retrained on an annual basis per contractual requirements.
Oversees the utilization management and disease management activities for the STAR Kids program.
Maintains appropriate team assignments based on volumes and communicates with the Director regarding status of current workload and turn- around time discrepancies as necessary. Must obtain approval from the Director or designee prior to any distribution of workload.
Recognizes and explains the unique requirements, benefits and services of the MDCP waiver to service coordination staff and internal and external partners.
Has the ability to understand STAR Kids program and benefits and is a resource for questions related to STAR Kids for service coordination staff including but not limited to MDCP, other waivers, consumer directed services, electronic visit verification, transition services, financial management, supported employment and employment assistance, and promoting independence.
Oversees coordination with all STAR Kids waiver programs.
Oversees all audits of the Service Coordination staff to monitor compliance with performance standards.
Oversees STAR Kids support staff, e.g. call center support staff, documentation support staff, or mail room staff.
Produce status reports on a regular basis concerning departmental activities and State required reports.
Collaborates with the Medical Director to develop action plans to address areas needing improvement.
Collaborates with Provider Relations and Network Management Departments for educating and contracting with long term services and support providers.
Acts as the liaison regarding medical management programs, services, and activities by working with providers, health plan, consultants, members and other staff.
Supervises the following job classes: RNs, LVNs, Social Workers and non-clinical staff.
Responsible for sound management of human resources.
Effectively administers performance management system including:
developmental feedback
goal setting
assesses competency
progressive discipline
evaluates clinical progress
reviews SAI and ISP accuracy
Participates in health plan’s performance improvement activities.
Participates in health plan committees as appropriate and on request.
Assists in maintaining SharePoint.
Makes and implements decisions compatible with organizational goals.
Maintains composure, effectiveness, and flexibility under pressure.
Provides on call for the 24 hours nurse advice line when directed.
Accepts other assignments from the Director as requested and complies with basic management principals of delegation.

Education and/or Experience:

Licensed by the appropriate State of Texas Licensing Board if licensed. Bachelor of Science in Nursing Health Education, Social Work, Public Health or related field required from four-year college or university or equivalent combination of education and experience in managed care, STAR+PLUS, children with special health care needs, or Long Term Services and Supports (LTSS) for individual enrolled in various waiver programs through the Department of Aging and Disability Services (DADS) preferred.
Masters in public health, Public Administration, Business Administration, Education, Health Administration, Nursing, Pharmacy, Respiratory Care, Therapy, Social Work or related clinical field. Administration or Public Health preferred.
Minimum of 3 years of clinical experience as a Registered Nurse with one year of experience as a case manager or managed care case/utilization management experience preferred.
Minimum of three (3) years prior management experience in health services within a managed care organization preferred.
Must have an in-depth knowledge of the State of Texas’ managed care and managed Medicaid process preferred.
Previous experience with the State of Texas STAR+PLUS program or similar programs dealing with SSI and disabled children preferred.
Knowledge of Medicare preferred.
MNLOC/RUG certification preferred

Licenses, Certifications, Registrations:

Current, active, and unrestricted RN licensure in the State of Texas
Certified Case Manager (CCM) designation preferred
Current Texas driver’s license and insurance maintained throughout the term of employment

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