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LTSS Service Care Manager

3 months ago

McAllen, United States Spectraforce Technologies Full time
Job Title: LTSS Care Manager

Duration: 7 Months (Potential to extend)

Location: Remote TX ( does require travel to team meetings a few times per year. Please source from TX

Meetings will be in McAllen, TX)

Shift: M-F 8-5

Responsibilities:
  • Telehealth assessments
  • Review assessments & service plans (vendor or internal assessments)
  • Follow up on pending assessment findings, clarify DX, reported abnormal, requested referrals, etc.
  • Hospital discharges follow up
  • 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, hearing, 90 day 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 identified except DME.
    • Submit DME tasks for newly identified DME items.




Required Skills/Experience:

Preferred Skills/ Experience:

1.
Excellent computer skills
1.
Previous MCO experience

2.
Proficient in Word, Excel, and PowerPoint
2.
Spanish Speaking preferred

3.

3.

Education Requirement:
BA-Social work
Education Preferred:

Software Skills Required: