Health Services Coordinator (HONDO)

POSITION SUMMARY/RESPONSIBILITIES Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed group to enhance financial outcomes. Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications. EDUCATION/EXPERIENCE Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review, or hospital quality assurance experience is preferred. LICENSURE/CERTIFICATION Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.

Patient Care Coordinator RN (BOERNE)

POSITION SUMMARY/RESPONSIBIILITIES The Service Coordinator-RN/NP/PA (SC-RN/NP/PA) provides STAR Kids Members with initial and ongoing assistance by identifying, selecting, obtaining, coordinating, and using Covered Services and other supports to enhance the Member's well-being, independence, integration in the community, and potential for productivity. The SC-RN/NP/PA provides a holistic evaluation of the Member's individual 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 Kids members' covered and uncovered services, including both acute and long term services and supports (LTSS), while meeting the Member's physical, behavioral, functional, and psychosocial needs. Complies with University Health System's and CFHP's policies, procedures and protocols for establishing and maintaining good working relationships with co-workers, Health System employees, patients and guests. EDUCATION/EXPERIENCE BSN is preferred. All candidates must possess at least five (5) recent years of clinical experience, which may include service coordination, case management, quality management or managed care experience. Working knowledge of ICD10, CPT4 coding, InterQual/M&R criteria, Texas Department of Insurance HMO standards, LTSS, and NCQA standards is preferred. Supervisory experience is preferred. LICENSURE RN must possess current licensure with the Texas State Board of Nurse Examiners. Current certification from an appropriate professional agency, such as the Case Management Society, is required or is to be obtained within 24 months of accepting the position.