LTSS Service Care Manager

Immediate need for a talented LTSS Service Care Manager. This is a 06 Months Contract opportunity with long-term potential and is located in TX (Remote-Must be from Hidalgo County TX). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-93144

Pay Range: $24 - $28/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
 
Key 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. 
• 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. 
• All services have been started with verifying. 
• 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.
• Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome
• Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialist, and/or community resources needed for long-term care.
• Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members.
• Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans.
• Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs.
• Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met.
• Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulator.
• May perform home and/or other site visits to assess member’s needs and collaborate with healthcare providers and partners.
• Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits.
• Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner

Key Requirements and Technology Experience:

• Skills-Excellent computer skills
• Proficient in Microsoft programs, i.e.. Word, Excel, and OneNote
• Previous MCO experience
• Education/Certification -Required: BS- Social Worker
• Years of experience required: prefer MCO experience
• Requires a bachelor’s degree and 2 – 4 years of related experience.
• Additional qualities to look for: Spanish speaking

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
 
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