LTSS Service Care Manager
2 weeks ago
Duration: 6 Months with potential to extend
Location: Remote
8:00 am - 5:00 pm
Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD):
- Telehealth assessments/ face to face if in area. (Bi-annual)
- 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.
- 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.
- 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.
- Submit DME tasks for newly identified DME items.
Required Skills/Experience:
Preferred Skills/ Experience:
1.
Excellent computer skills
1.
Previous MCO experience or previous IDD waiver experience preferred
2.
Proficient with Microsoft Word, Outlook and Excel
2.
Bilingual preferred
3.
3.
Education Requirement:
BS in Social Work
Education Preferred:
SW license preferred
Required Certifications:
n/a
Is DFPS check required?
Required Testing:
n/a
Software Skills Required:
n/a
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Dallas, Texas, United States Centene Corporation Full timeAbout the RoleWe are seeking a highly skilled Senior LTSS Service Care Manager to join our team at Centene Corporation. As a key member of our care management team, you will play a vital role in transforming the health of our communities by providing exceptional patient care and advocacy.
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