The Nurse Service Coordinator is a registered nurse responsible for coordinating long-term services and supports (LTSS) for members, including developing and monitoring care plans to optimize health outcomes. They conduct holistic assessments, provide education to members and their support networks, and ensure compliance with relevant policies and standards. The role requires experience in clinical nursing, knowledge of Medicare/Medicaid HMO standards, and coordination of both acute and long-term care services.
POSITION SUMMARY/RESPONSIBILITIES
The RN Service Coordinator-RN (RN-SC) contributes to the Long-Term Services and Supports (LTSS) service coordination process by performing activities within the scope of licensure; provides supervision and direction to staff participating in Member’s cases following applicable state law and contract; develops, monitors, evaluates, and revises the Members’ care plans to meet Member’s needs, to optimize health care across the care continuum to enhance the Member's well-being, independence, integration in the community, and potential for productivity. The RN-SC conducts a holistic assessment of the Member's dynamics, needs, and preferences while providing education and health-related information to the Member, the Member’s Legal Authorized Representative (LAR), and the Member’s Support Network. Responsible for the coordination of STAR+PLUS Members' covered and non-capitated services, including acute and LTSS, while meeting the Member's physical, behavioral, functional, and psychosocial needs. Complies with policies, procedures, and protocols for establishing and maintaining good working relationships with co-workers, employees, patients, and guests .
EDUCATION/EXPERIENCE
Graduation from an accredited school of professional nursing or social work is required . BSN is preferred. Four (4) recent years of clinical experience preferred, which may include service coordination, case management, quality management, or managed care experience. Working knowledge of HMO standards, LTSS, and NCQA standards is preferred. Knowledge of Medicare and Medicaid HMO experience is preferred. Experience in meeting the needs of vulnerable populations who have chronic or complex conditions is required. Bilingual, English/Spanish is preferred.
LICENSURE/ CERTIFICATION
A current, unrestricted license to practice professional nursing issued by the State of Texas is required.RUG Certification is required and must be obtained within 30 days of employment for all RN candidates.
Nurse Service Coordinator, Long-Term Services and Supports, Care Coordination, Registered Nurse, Case Management, Medicare, Medicaid, Managed Care, Patient Assessment, Healthcare