LTSS Service Care Manager - J01031
Axelon Services CorporationMcAllen, TX2 days ago
Job type
- Full-time
- Quick Apply
Job descriptionResearch community resources. Update LTSS Terminate LTSS waiver service authorizations. Provide community resources. Instruct member on appeal process and level change. Initiate LTSS / acute services (create authorization request template) Research complaints and provide updates to managers for complaint responses. MSC call backs. CDS review Acute UM denials to include PT denial, request for more information. Create clinical reviews / IRTs CIC, CIS without MNLOC completion. Fair hearing assistance as needed. Determine MN for post assessment identified items. Verify all services have been started. Follow up on all non DME identified needs. Submit DME tasks for newly identified DME items. Required : BS- Social Worker Preferred : Required : Preferred : Years of experience required : prefer MCO experience Requires a Bachelor's degree and 2 – 4 years of related experience. Spanish speaking Excellent computer skills Proficient in Microsoft programs, i.e., Word, Excel, and OneNote Previous MCO experience
Job Title : LTSS Service Care Manager
Location : Remote- Texas; preferably Hidalgo SDA
Shift : Monday- Friday 8-5; possibility for OT
Duration : 6 months, possibility to extend.
Job Description :
- Review assessments & service plans (internal assessments)
- Follow up on pending assessment findings, clarify DX, reported abnormal findings, requested referrals, etc.
MN denials
2065D approval / denials
Escalations
Dental, nursing, vision, verify service utilization, 28 day follow ups.
Send required referrals for new services / items identified except DME.
Candidate Requirements
Education / Certification
Licensure
Additional qualities to look for :
Top 3 must-have hard skills stack-ranked by importance :
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Care Manager • McAllen, TX
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