Population Health Resource Coordinator

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 Pop Health Resource Coordinator will serve as an Advocate/Representative for:

• Members that may qualify for various waivers established by the Texas Department of Aging and Disability (DADS). The incumbent will work with identified members to determine the member’s waiver eligibility, submit information to DADS for determining waiver eligibility, and assisting the member’s legally authorized representative (LAR) to comply with DADS requirements.
• Members seeking disability services with Social Security Administration (SSA). The incumbent will gather pertinent health history as it relates to member’s disability, assist qualifying members determine required documentation, perform telephonic outreach and/or home/site visits to procure medical evidence and complete necessary applications. The Population Health Resource Coordination will maintain ongoing contact with SSA and member to update on case status and will maintain current logs and reports of case outcomes.
  
  
  

The Pop Health Resource Coordinator will also assist in:

• Will serve as DHP’s NEMT delegate helping members access DHP’s value-added benefits, if applicable, coordinating services with and/or referring members to agencies and community-based programs as needed, and assisting members in their application for Medicare benefits where appropriate.
  
  
  

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 Health Plan leadership, as required.

Knowledge, Skills and Abilities:

Working knowledge of current Medicare/Medicaid guidelines. Community agencies/resources, financial programs, i.e., AFDC/SSI. Familiar with Health and Human services as it pertains to disability criteria. Experience with largely pediatric populations. Ability to work with multidisciplinary staff. Ability to work with individuals with intellectual and physical disabilities within a therapeutic interdisciplinary environment. Communicate effectively in oral and written communication, trains others, maintain records, and prepares concise reports. Microsoft Office skills preferred. Maintains utmost level of confidentiality at all times. Maintains compliance with regulatory agencies that conduct intermittent reviews and audits to ensure contractual and regulatory compliance with Federal, State entities as well URAC. Implements and adheres to Health System and Health Plan policies and procedures for all members as well as those with special health care needs (STAR Kids, STAR, CHIP, STAR AAPCA) Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.

Responsibilities:

Function in an advisory role to the Medical Directors and Medical Management Committee in the following areas:

• Provide evaluation of and assist in the development of quality patient care services offered by DCHP;
• Assist in the establishment of patient care and professional staff policies and procedures of DCHP; and
• Participate in long-range planning of services and/or programs offered by DCHP.
  
  
  

This position shall be responsible for the following aspects of the program:

• Working with families that may be in crisis
• Working with largely pediatric populations
• Working with multidisciplinary staff
• Developing professional relationships with, and knowledge of aftercare resources, including their scope and referral process requirements to improve the patient safety into the community. (i.e., state and regional forms of assistance, housing, and entitlements)
• Maintaining an updated training guide on disability screening and application process
• Participating in the planning development of the health plan member’s care by maintaining a through and current understanding of criteria and benefits established by DCHP to obtain reimbursement
• Performing all administrative duties in a timely manner
• Maintaining proper documentation of services
• Sharing with other multi-disciplinary members, information that will enhance effectiveness and outcome of plan of care
• Assisting members in enrolling and receiving services from other waivers or community based programs
• Assuring members receive all authorized long term supports and services (LTSS)
• Other responsibilities as assigned by leadership
  
  
  

Education and/or Experience:

• Must have a high school diploma or equivalent. CHW certification preferred.
• Experience and knowledge of Social Security Administration SSI/SSDI programs.
• Previous experience in managed care environment preferred.
• Previous experience at the Texas Health and Human Services Commission (HHSC) or the Department of Aging and Disability Services (DADS) a plus.
  
  
  

Language Skills:

• Ability to speak and read in English and Spanish.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers, employees, or contractors/agents of organization.