Knowledge Services Jobs in Usa

Rheinmetall 4iG Digital Services (R4) is a joint venture between Rheinmetall, a globally leading supplier of defense and automotive products, and 4iG, Hungary's leading IT systems integrator. R4 has been founded end of 2022 with its headquarters in Budapest and the initial mission to provide project- and operations-related IT services to Rheinmetall's local subsidiaries in Hungary and worldwide. Based on business requirements and opportunities, R4 plans to progressively expand the scope of its services for internal and external customers alike. In a nutshell, R4 is like a start-up with guaranteed success. Equipped with a hands-on mentality, it significantly benefits from the support and tremendous growth of both Rheinmetall and 4iG. The designated business and solid setup offer outstanding development potentials for R4 itself but consequently also for all employees, because there will be lots of interesting jobs in an international and dynamic work environment.

In order to achieve our common goals, we count on you

* Design, implementation and operation of print management system and print servers.

* Takes over communication with the service provider and processes reported problems in close cooperation with the service provider

* Approves the system settings for the printing functions provided by the service provider and ensures that they are maintained

* Improves existing processes and technical solutions

* Is an active member of the team and contributes to continuous optimization with their experience

What you will need for successful work

* Degree in computer science, information technology, business information technology, or related field with relevant working experience

* Professional experience (min. 3 years) with print servers and printing solutions (follow me printing)

* Professional experience with printer hardware (especially Konica Minolta printers)

* Thorough knowledge of modern print management software

* Basic knowledge of networks, databases and application servers

* Recognising and communicating technical, structural and organisational problems and developing proactive solutions

* Close cooperation with other departments within the organisation

* Thorough work ethic with attention to detail

* Strong analytical skills combined with a strong service and customer focus

* Independent, proactive work

* Positive and solution-oriented mindset, team spirit

* Business fluent English and Hungarian, both written and spoken

What we offer

* Take over an important and challenging role with high visibility

* Become part of the unique growth stories of Rheinmetall and 4iG, which offer outstanding development and career opportunities

* Gain insight into the defense and automotive industry

* Make use of the broad network with over 30.000 great colleagues at Rheinmetall and 4iG worldwide

* Benefit from various professional trainings and events

* Enjoy our international and flexible work environment with an official office in Budapest but up to 100% mobile work

What we are happy about

* Experience with SafeQ, Siteaudit, and Autostore systems

* Knowledge of ITIL processes

* Experience with ServiceNow

* Software release management

* German language skills are an advantage

Hybrid: Applicants must be a California resident as of their first day of employment.

PRINCIPAL RESPONSIBILITIES:

Member Services Representatives (MSR) are the first point of contact for our members' primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a timely manner. Respond to all communications coming into Member Services in the form of email, fax, letters, chat and phone calls. Timely responses to all member communication are essential. Must effectively prioritize and flex the workload as new communication and tasks are submitted. Identify the caller's needs, clarify information, research issues, and provide solutions and/or alternatives whenever possible. Accurately and consistently document all conversations in the electronic database. This position is a liaison between the plan, the provider network, and other community agencies. The MSR positions are flexibly staffed classification and work is expected to be performed minimally at the MRS II level. However, the initial selection will be made at the entry level MSR I. Our more advanced level position of the series is the MSR III who will be required to perform a variety of complex matters.

Member Services Representatives are under the direction of a Member Services Supervisor, Manager and Director, and service our members through our call center as well assisting other departments with responses to member issues by initiating communication between departments to ensure action, cooperation, and compliance of managed care operations.

Member Services Representative I

This position which requires the ability to work as a team player within the Alliance and with external contacts, make sound judgments based on analysis of information, be an effective communicator, active listener and balance advocacy for the member with the policy provisions such as plan policies, EOC, regulatory guidelines, and DMHC/DHCS rules and regulations. The MSR provides courteous, professional, and accurate responses to incoming inquiries regarding network, plan benefits, eligibility, authorizations, plan services and guidelines, as well make decisions with the goal of ensuring member satisfaction and retention. The MSR performs a variety of complex functions and is also responsible for maintaining accurate and complete inquiry/grievance records in the electronic database. Maintains compliance with DMHC regulatory requirements and DHCS contractual obligations. MSR I staff who demonstrate proficiency in meeting, maintaining and exceeding principal performance objectives and metrics may be eligible to be promoted to a Member Services II or III role. Member Services Representative I staff may be eligible for promotion to Member Services Representative II or III positions once they have worked as a MSR I for a minimum of 12 months to be proficient with program and system knowledge in addition to meeting performance matrix requirements.

Principle duties and responsibilities

* Serve as the primary contact for members, providers and others for questions related to claims, benefits, authorizations, pharmacy, member eligibility and other questions related to Alameda Alliance and provide accurate, satisfactory answers to their inquiries or concerns.

* Respond to and resolve member service inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, behavioral health, and care coordination.

* Answer incoming calls, emails, chats, and other requests for assistance in a timely manner in accordance with departmental performance targets and provide excellent customer service while doing so. May include assisting members in person.

* Recognize and understand the difference between calls that require quick resolutions and calls which will require follow-up and handle each appropriately.

* De-escalate situations involving dissatisfied customers, offering patient assistance and support.

* Accurately document all contacts per department standards/guidelines in the Customer Relationship Management (CRM) system.

* Accurately and consistently document (electronic database) and resolve Exempt Grievances (any expression of dissatisfaction that are not coverage disputes, disputed health care services involving medical necessity, or experimental or investigational treatment and that are resolved by the next business day following receipt).

* Interface with Grievance and Appeals, Claims, Enrollment, IT, Network Management, Pharmacy, Authorizations, and other internal departments to provide Service Excellence to our members.

* Help guide and educate members about the fundamentals and benefits of managed health care topics, to include managing their health and well-being by selecting the best benefit plan service options, maximizing the value of their health plan benefits, and choosing a quality care provider.

* Intercede with care providers (doctor's offices) on behalf of the member, assisting with appointment scheduling; connect members with internal Case Management Department for assistance as needed.

* Assist members in navigating , the Member Portal, and other health care partner online resources and websites to encourage/reassure them to use self- service tools that are available.

* Manage any issues through to resolution on behalf of the member, either on a single call or through comprehensive and timely follow-up.

* Research complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues.

* Provide education and status on previously submitted pre-authorizations or pre- determination requests for both medical and pharmaceutical benefits.

* Meet the performance goals established for the position in the areas of compliance, efficiency, call quality, member satisfaction, first call resolution, punctuality, and attendance.

* Always maintain a professional level of service to members.

* Always maintain confidentiality of information.

* Consistently support the Alliance's approach to Service Excellence by adhering to established department and company standards for all work-related functions.

* Interact positively with all Alliance Departments.

* Accurately and consistently document (electronic database) and resolve Exempt Grievances (any expression of dissatisfaction that are not coverage disputes, disputed health care services involving medical necessity, or experimental or investigational treatment and that are resolved by the next business day following receipt).

* Process MS Dept projects

* Serve as a back-up to manage the escalated calls.

* Perform other duties as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

* Contacts: Receive, manage, and document telephone calls, emails, and other sources of contacts from members, potential members, and providers, and explain health plan benefits and plan rules. Describe the types of services the Alliance offers to the Member within the managed care system. Provide clarification about issues regarding patient and physician rights and how the plan operates.

* Conflict resolution: Resolve member problems/conflicts by convening with other departmental staff as needed.

* Member communications: Create and/or mail appropriate member materials and communications as needed.

* Computer: Perform ongoing data entry which assists in the maintenance of the Member Services department database to ensure data integrity.

* Comply with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

* Constant and close visual work at desk or computer.

* Constant sitting and working at desk.

* Constant data entry using keyboard and/or mouse.

* Constant use of multi-monitor setup

* Frequent use of telephone and headset.

* Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.

* Frequent lifting of folders, files, binders, and other objects weighing between 0 and 30 lbs.

* Frequent walking and Standing

Number of Employees Supervised: 0

MINIMUM QUALIFICATIONS:

* Bachelor's degree or equivalent experience preferred.

* High school diploma, GED required.

* The ability to speak and understand-bilingual: Spanish/English, Cantonese/English, Vietnamese/English, Tagalog/English are required as designated.

* A bilingual proficiency exam will be administered to ensure the candidate possesses the appropriate skill level to meet requirements. The successful candidate must score 90% or higher.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

* Minimum one year of direct customer service experience. Call center experience and managed care experience a plus

* Experience determining eligibility for financial assistance, insurance benefits, unemployment and/or other social services programs.

* Demonstrated knowledge expert of AAH Member Services policies and procedures

* Consistent record of meeting, maintaining, or exceeding monthly Departmental performance metrics.

* Consistent track record of documenting Service Requests accurately and clearly and monitoring open Service Requests to ensure responses and closure.

* Consistent record of high quality of work as demonstrated through call and documentation auditing, appropriate Call Disposition coding, as well as an overall acceptable monthly Member Satisfaction Survey result as assessed by Member Services Quality Specialist, MS Trainer and Member Services Supervisor.

* Demonstrated proficiency in current Customer Relationship Management (CRM) tool, phone system software Quality Management Solution, Pharmacy Benefits Management applications (PBM), Interpreter vendor scheduling software, delegate portal solutions and the Alliance's Member portal.

* Demonstrated ability to effectively handle the department's key special projects: Member Portal Request Processing, Kaiser PTE Requests, PCP retroactive and same month requests.

* Demonstrated ability to help members face-to-face in the field and/or at the Alliance offices (walk-ins). Also highly skilled at handling issues related to member bills, transportation set-up and benefit coordination with providers and pharmacy needs.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

* Ability to prioritize and adapt to changing situations in a calm and professional manner.

* Ability to maintain composure in stressful situations.

* Excellent problem-solving skills

* Ability to exhibit cooperation, flexibility, and provide assistance when talking to members, providers, and staff.

* Skill in basic data entry

* Ability to type 40 net words per minute: multi-task

* Manual dexterity to operate telephone, computer keyboard equipment.

* Speak English proficiently, clearly, and audibly.

* Memorize and retain information quickly; meet physical requirements

* Spell correctly

* Learn the policies, regulations, and rules applicable to business operations.

* Follow instructions, reason clearly, analyze solutions accurately, act quickly and effectively in emergency situations; operate office equipment including computers and supporting word processing, spreadsheet, and database applications.

* Excellent phone etiquette and ability to communicate clearly and concisely, both orally and in writing.

* Excellent interpersonal skills with the ability to interact with diverse individuals and flexibility to customize approach to meet all types of member communication styles and personalities.

* Strong verbal and written communication skills.

* Demonstrated ability to quickly build rapport and respond to members in a compassionate manner by identifying and exceeding member expectations (responding in respectful, timely manner, consistently meeting commitments).

* Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests, and identify the current and future needs of the member.

* Must be self-motivated and able to work with minimal supervision

* Must be team-oriented and focused on achieving organizational goals.

* Proficient problem-solving approach to quickly assess current state and formulate recommendations.

* Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions which members can understand and act upon.

* Proficient conflict management skills to include ability to resolve issues during stressful situations and demonstrating personal resilience.

* Ability to work regularly scheduled shifts within the Alliance's hours of operation including the training period, with scheduled lunches and breaks, flexibility to adjust daily schedules; and to work over-time and/or weekends as needed.

* Medical terminology knowledge preferred

* Ability to work within a broad systems perspective

* Experience in use of various computer systems software as well as Microsoft Windows, and Microsoft Suite, especially Outlook, Word, Excel.

* Must have reliable and stable internet connection for remote work (50-100 Mbps download speeds).

Employees who interact with members of the public may be required to be tested for Tuberculosis and fully vaccinated against COVID-19 and influenza. Successful candidates for those positions/ classifications may be required to submit proof of vaccination against influenza and/or COVID-19, a negative Tuberculosis test, or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates should not present proof of vaccination until instructed to do so by the Human Resources department.

SALARY RANGE $22.88-$34.33 HOURLY

The Alliance is an equal opportunity employer and makes all employment decisions on the basis of merit and business necessity. We strive to have the best-qualified person in every job. The Alliance prohibits unlawful discrimination against any employee or applicant for employment based on race, color, religious creed, sex, gender, transgender status, age, sexual orientation, national origin, ethnicity, citizenship, ancestry, religion, marital status, familial status, status as a victim of domestic violence, assault or stalking, military service/veteran status, physical or mental disability, genetic information, medical condition, employees requesting accommodation of a disability or religious belief, political affiliation or activities, or any other status protected by federal, state, or local laws.

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

• No experience needed

Customer Service Support Supervisor

The Customer Support Service Supervisor is responsible for the independent oversight of all dispatch operations within their assigned service team, territory, or region. Acting as the primary point of contact within the Service Coordination group, the Supervisor ensures seamless communication among customers, technicians, and management, while delivering timely and efficient customer service. This role serves as both a subject matter expert in Customer Support Services Team (CSST) processes and a trainer/mentor for Service Coordinators and administrative staff. With minimal direct oversight, the Supervisor exercises sound judgment and decision-making authority to resolve issues, enhance processes, and ensure adherence to service and company standards.

Principal Duties and Accountabilities:

Supervision & Leadership

• Serve as the direct line of support for Service Coordinators/Administrative Assistants within the region.
• Monitor, train, and mentor Service Coordinators, ensuring clear understanding of processes, compliance, and performance expectations.
• Conduct quarterly performance reviews and routine one-on-ones with assigned team members.
• Support Operations Manager in maintaining appropriate staffing levels by communicating manpower needs.
• Participate in performance management, coaching, and the evaluation process for service staff.
• Collaborate with the Director of the Customer Service Support Team on team compensation, benefits, and feedback initiatives.
• Utilize software platforms to review team and operational reports, track goal achievement, and identify opportunities for process and performance improvements.
• Ensure accurate and compliant execution of customer portal management activities performed by the Senior Service Coordinator, providing oversight and guidance as needed. Serving as backup
• Seek approval from management before enforcing exceptions to CSST policies or taking disciplinary action.

Dispatch Operations

• Manage all aspects of dispatch operations, including scheduling, prioritization, and technician assignments.
• Maintain the service work order process—ensuring accurate client/job creation, scheduling, and tracking in the Dispatch Board.
• Monitor ongoing service work assignments and technician locations through active communication.
• Receive and process incoming customer service requests; make rapid decisions to route calls appropriately.
• Act as point of escalation for complex service issues or customer concerns.
• Utilize data and analytics to identify service trends and efficiency opportunities.
• Manage weekly payroll and timekeeping for assigned technicians, acting as back up to the Service Coordinators as needed.
• Provide backup support to Service Coordinators as needed.

Job Management

• Establish new work orders in the accounting system for both new and existing customers.
• Partner with Project Managers, Account Managers, and Technicians to ensure timely work order completion and billing accuracy.
• Ensure proper documentation and accuracy in all service-related information.

Sales Collaboration

• Partner with the Sales department by providing insights into service capabilities, scheduling considerations, and resource requirements to support customer proposals and service agreements.
• Attend site walks for new service agreements; meet directly with customers to gather and verify accurate billing information, site details, and key contact information.
• Collaborate with Sales to ensure smooth handoffs from the pre-sales process to active service delivery, helping establish realistic customer expectations and seamless onboarding.

Process Improvement & Development

• Regularly evaluate customer support and operations processes; recommend enhancement opportunities to the department director.
• Stay current with industry best practices, service software applications, and workflow optimization strategies.

Education:

• High School Diploma or equivalent required; Associate or Bachelor’s degree preferred.
• General courses in accounting preferred.

Experience:

• Minimum 4 years’ experience in a customer service-related role with exposure to operations or accounting administration.
• Minimum 3 years’ experience as a Service Coordinator or Dispatcher.
• Knowledge of commercial HVAC systems, equipment, and terminology required.
• In-depth understanding of dispatch center operations, scheduling, and resource allocation.
• Proficiency with service software systems and Microsoft Office Suite; knowledge of Access and accounting platforms preferred

Knowledge, skills, and abilities:

• Proven ability to work independently, make proactive decisions, and prioritize effectively in high-volume, fast-paced environments.
• Strong leadership and mentoring skills with ability to foster collaboration within the team.
• Excellent customer service and interpersonal skills; able to handle escalated issues with professionalism.
• Exceptional organizational skills with attention to accuracy in scheduling, records, and customer information.
• Strong problem-solving and analytical skills; ability to interpret data for improved decision-making.
• Effective verbal and written communication skills with customers, staff, and management.
• Demonstrated confidentiality and professionalism with sensitive topics (payroll, benefits, performance).
• Commitment to professional growth and the development of new skills to support evolving operational and technological needs
• Ability to adapt to changing circumstances, handle unexpected challenges, and remain composed under pressure.
• Proficiency in operating computer systems, software, and communication devices required for dispatch operations, including data entry and handling various administrative tasks.
• Capacity to analyze complex situations, identify patterns, and make informed decisions in a fast-paced and time-sensitive environment.
• Capability to handle high-pressure situations, such as managing urgent service calls or resolving conflicts, while maintaining composure and professionalism.
• Ability to quickly assess problems or issues, evaluate available options, and implement effective solutions to maintain service quality and customer satisfaction.
• Skill to make sound judgments based on available information, company policies, and customer needs, ensuring the best outcomes for all parties involved.
• Flexibility to adjust plans, schedules, and resource allocation in response to changing priorities, emergencies, or unforeseen circumstances.

Physical and/or travel demands:

• Some travel may be required.
• This position is done in a typical office setting, mostly sitting at a desk. Frequent use of computer keyboard, monitor, and telephone. Some standing, bending, and lifting light files is required.
• May require occasional bending, stooping, and lifting of files, light office equipment, etc.

Benefits and Compensation:

• The range for this position has been established at $72,000 to $101,000 per year and is U.S. Engineering - Service's good faith and reasonable estimate at the time of the posting. The compensation offered to the finalist selected for this role will be based on a variety of factors, including but not limited to internal equity, experience, education, specialty, and training. Compensation for this role includes a base salary complemented by commission opportunities based on the Account Manager’s individual sales performance and attainment of sales targets
• Your total compensation will go beyond the number on your paycheck. Team members are eligible for a year-end bonus based on company and/or individual performance as well as paid time off. An industry-leading benefits package, including health, dental, and vision plans, matching retirement contributions, and matching 529 contributions all add to your bottom line.

To apply, please visit must be legally authorized to work in the United States on a full-time basis without requiring future sponsorship for employment visa status.

U.S. Engineering - Service is an Equal Employment Opportunity Employer and shall provide equal employment opportunities to all people in all aspects of employer-employee relations, without regard to race, color, creed, national origin, religion, sex, age, sexual orientation, gender identity, disability or veteran status.

U.S. Engineering - Service is compliant with the Drug Free Workplace Act, and all offers of employment are contingent upon the completion of a pre-employment drug screen.

Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this position. They are not intended to be construed as an exhaustive list of all responsibilities and job specifications required of employees so classified. U.S. Engineering reserves the right to revise as needed. The job description does not constitute a written or implied contract of employment.

Who We Are

As the nation's largest producer of clean, carbon-free energy, Constellation is focused on our purpose: accelerating the transition to a carbon-free future. We have been the leader in clean energy production for more than a decade, and we are cultivating a workplace where our employees can grow, thrive, and contribute.

Our culture and employee experience make it clear: We are powered by passion and purpose. Together, we're creating healthier communities and a cleaner planet, and our people are the driving force behind our success. At Constellation, you can build a fulfilling career with opportunities to learn, grow and make an impact. By doing our best work and meeting new challenges, we can accomplish great things and help fight climate change. Join us to lead the clean energy future.

Total Rewards

Constellation offers a wide range of benefits and rewards to help our employees thrive professionally and personally. We provide competitive compensation and benefits that support both employees and their families, helping them prepare for the future. In addition to highly competitive salaries, we offer a bonus program, 401(k) with company match, employee stock purchase program comprehensive medical, dental and vision benefits, including a robust wellness program paid time off for vacation, holidays, and sick days and much more.

Expected salary range of $117,900 to $131,000, varies based on experience, along with comprehensive benefits package that includes bonus and 401(k).

Primary Purpose of Position

Performs advanced technical/engineering problem solving in support of nuclear plant operations. Responsible for technical decisions. Possesses excellent knowledge in functional discipline and its practical application and has detailed knowledge of applicable industry codes and regulations.

Primary Duties and Accountabilities

• Provide in-depth technical expertise to develop, manage and implement engineering analysis, activities and programs.
• Provide technical expertise and consultation through direct involvement to identify and resolve equipment and system problems.
• Provide complete task management of engineering issues.
• Perform engineering and technical tasks as assigned by supervision applying general engineering principles
• Accountable for the accuracy, completeness, and timeliness of work ensuring proper configuration management and assuring that standard design criteria, practices, procedures and codes are used in preparation of plans and specifications.
• Perform independent research, reviews, studies and analyses in support of regulatory/technical projects and programs.
• Recommend equipment, new concepts and techniques to improve performance, simplify construction, reduce costs, correct design or material flaws, or comply with changes in codes or regulations.
• Must be willing to travel 10-50% of time, which may be to another Constellation Clean Energy Center.
• All other job assignments and/or duties pursuant to company policy or as directed by management to include but not limited to: (positions outside of department in support of outage activities etc.)

Minimum Qualifications

• Bachelor's degree in engineering (chemical, civil/structural, electrical, industrial, mechanical or nuclear) or technical discipline (e.g. chemistry, computer science, mathematics, or physics) with 5 years of industry experience or 3 years of Constellation Reactor Services department experience OR
• Current or previous Senior Reactor Operator license with 5 years of industry experience or 3 years of Constellation Reactor Services experience department OR
• Associates/non-technical 4-year degree/completion or a relevant, skilled trades apprenticeship program (e.g., boilermaker, pipefitter, operating engineer) with 7 years of industry experience or 5 years of Constellation Reactor Services department experience OR
• High school diploma/GED with 9 years of industry experience or 7 years Constellation Reactor Services experience department
• Maintain minimum access requirement or unescorted access requirements, as applicable, and favorable medical examination and/or testing in accordance with position duties

Preferred Qualifications

• Professional Engineer Certification
• Advanced technical degree or related coursework
• Design Engineering Qualifications
• Fuel Handling Qualifications and Experience
• Lifting and Rigging Experience
• Master Rigger Qualification
• Work Planning Qualifications
• Procedure Revision Experience
• Supervisory Qualifications and Experience
• P6 Scheduling Experience

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.

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.

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.