Job Title : Licensed Master SocialWorker
Duration : 6months
Shift : Monday Friday8 : 00am 5 : 00pm
LocationMcAllen TXwill get training in the office for 12weeks.
Must have License master social worker
Must have degree in Social Worker
Responsibilities :
- Review assessments & service plans (vendor orinternal assessments)
- Follow up on pendingassessment findings clarify DX reported abnormal requestedreferrals etc.
- Hospital discharges followup.
- MN denials
- Researchcommunity resources.
- 2065Dapproval / denials
- Update LTSS
- Terminate LTSS waiver service authorizations.
- Provide community resources.
- Instruct members on appeal process and level change.
- ISP updates (internal) 17003 obtain verbalapproval and update form update 17002 with waiver items.
- Initiate LTSS / acute services (createauthorization request template)
- Researchcomplaints and provide updates to managers for complaint responses.
- Escalations
- MSC callbacks.
- CDS review
- AcuteUM denials to include PT denial request for more information.
- Create clinical reviews / IRTs.
- CIC CIS without MNLOC completion.
- Fair hearing assistance is needed.
- Determine MN for post assessment identified items.
- Dental nursing vision verify serviceutilization hearing 90day MHM 28 day follow ups.
- Verify all services have been started.
- Follow up on all non DME identified needs.
- Send required referrals for new services / items identifiedexcept DME.
- Submit DME tasks for newlyidentified DME items.
Describe the performance expectations / metrics forthis individual and their team :
Review monthly audits and weekly calls to ensure we aremeeting contractual requirements.
Tell me about what their first day lookslike :
Will call theemployee to make sure they are signed in. They will complete newhire training.
Whatprevious job titles or background work will be in thisrole
ServiceCoordinator
What makesyour team / department / culture special that you would like candidatesto know
Greatcollaboration amongst team
Required Skills / Experience :
- Excellent computer skills
- Proficient in Word Excel and PowerPoint
Education Requirement :
- BSSocial Worker
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