Clinical - LTSS Service Care Manager GA

3 days ago


atlanta, United States Axelon Services Corporation Full time

Location: Remote, Texas, preferably Nueces SDA
Shift: M - F 8am – 5pm
Duration: 6+ months
*This is a Social Worker position. They will support the Star Plus Waiver member population. The position is remote; however, it's preferred that they are located in or near the Nueces SDA. Preferred work experience: Medicaid MCO.
Walk me through the day-to-day responsibilities of this the role and a description of the project

  • 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.




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