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Service Care Manager
3 months ago
** Fully Remote Position but does require travel to team meetings a few times per year**
Meetings will be in McAllen, TX
Desired Education: BA-Social Work
Day-to-day responsibilities of this the role:
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
o Research community resources.
2065D approval/denials
o Update LTSS
o Terminate LTSS waiver service authorizations.
o Provide community resources.
o 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
o 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.
o Verify all services have been started.
o Follow up on all non DME identified needs.
Send required referrals for new services/items identified except DME.
o Submit DME tasks for newly identified DME items.
Previous job titles or background.
- Service Coordinator
Required Skills/Experience:
Excellent computer skills
Proficient in Word, Excel, and PowerPoint
Preferred Skills/ Experience:
Previous MCO experience
Spanish Speaking preferred
