JOB SUMMARY
The New Member Clinical Coordinator will play a crucial role in assessing new enrolled STAR+PLUS members and providing excellent support though overflow call management. This compassionate New Member Clinical Coordinator is responsible for overall management of member's case within the scope of licensure; provides direction to clinicians participating in the member's case in accordance with applicable state law and contract; initiate and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum. The New Member Clinical Coordinator will perform telephonic assessments as mandated by state and federal regulations.
JOB SPECIFICATIONS AND CORE COMPETENCIES
- Assess, plan, and implement care strategies that are individualized by member and directed toward the most appropriate, lease restrictive level of care.
- Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services.
- Initiate care plan to ensure to ensure that care is provided at the beginning.
- Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members.
- Perform telephonic clinical assessments for the identification, evaluation, coordination and management of members needs, including physical health, behavioral health, social services and long-term services and supports.
- Identify members for high-risk complications and coordinates care in conjunction with the member and the health care team.
- Identify members with chronic illnesses, co-morbidities, and/or disabilities.
- Assists in meeting member needs by referring members to internal and external resources.
- Address member concerns, provide information, and facilitate problem resolution.
- Provide efficient and professional support for overflow calls for assigned Service Coordination team and Service Coordination Hotline as needed, ensuring timely and accurate responses to member inquiries.
- Collaborate with other team members to ensure seamless call handling and quality service delivery.
- Generate and submit necessary reports and documentation in compliance with organizational and regulatory requirements.
- Provide input and/or data to direct supervisor/manager related to any internal or external mandatory audit or reporting.
- Serve as mentor, subject matter expert or preceptor to new staff. Involved in process improvement initiatives.
- Assist in problem solving with providers, claims or service issues. People/Team Development.
- Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
QUALIFICATIONS:
- Education/Specialized Training/Licensure: Requires a current unrestricted LVN or RN license in Texas.
- Work Experience (Years and Area): 2-4 years nursing experience triaging and working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator or Case Management
- Experience in long-term care, home health, hospice, public health, or assisted living.
- Software Proficiencies: Microsoft Office, Clinical documentation platforms, Internet