LTSS Service Care Manager

Position Title: LTSS Service Care Manager
Work Location: Remote, Source from McAllen
Assignment Duration: 6 months
Work Schedule: Mon-Friday, 8 am-5 pm

Responsibilities:

• Review assessments & service plans (internal assessments)
• Follow up on pending assessment findings, clarify DX, reported abnormal findings, requested referrals, etc.
• MN denials
  • Research community resources.
• 2065D approval/denials
• Update LTSS
• Terminate LTSS waiver service authorizations.
• Provide community resources.
• Instruct member on appeal process and level change.
• ISP updates (internal), 1700-3 obtain verbal approval and update form, update 1700-2 with waiver items.
• Initiate LTSS/acute services (create authorization request template)
• Research complaints and provide updates to managers for complaint responses.
• Escalations
  • 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.
• Dental, nursing, vision, verify service utilization, 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 identified except DME.
• Submit DME tasks for newly identified DME items

Candidate Requirements
Education/Certification	Required: BS - Social Worker	Preferred:
Licensure	Required: Social Worker	Preferred:
Years of experience required: At least 2 years as social worker, Disqualifiers: Not having a BS in social work Additional qualities to look for: N/A
Top 3 must-have hard skills stack-ranked by importance	1	Computer Skills
2	Previous experience with a MCO
3	Excellent communication skills