Client Care Manager

2 weeks ago


Houston, Texas, United States Media Riders Inc. Full time

** Remote Opportunity with Occasional Travel for Team Meetings**

Desired Qualifications: Bachelor's Degree in Social Work

Key Responsibilities:

· Conduct telehealth evaluations

· Assess and review service plans and evaluations

· Follow up on outstanding assessment results, clarify diagnoses, and manage referrals

· Coordinate post-hospital discharge follow-ups

· Address MN denials and research community resources

· Manage 2065D approvals and denials

· Update Long-Term Services and Supports (LTSS) records

· Terminate LTSS waiver service authorizations as necessary

· Provide community resource information to members

· Guide members through the appeals process and service level changes

· Update Internal Service Plans (ISP) and obtain necessary approvals

· Initiate requests for LTSS and acute services

· Investigate complaints and provide updates for management responses

· Handle escalations and manage MSC callbacks

· Review Consumer Directed Services (CDS)

· Address acute Utilization Management (UM) denials, including requests for additional information

· Create clinical reviews and Incident Review Teams (IRTs)

· Assist with Fair Hearing processes as required

· Determine MN for items identified post-assessment

· Verify service utilization for dental, nursing, vision, and hearing services

· Ensure all services have commenced and follow up on non-DME needs

· Submit referrals for newly identified services, excluding DME

Previous Experience:

  • · Service Coordinator

Essential Skills:

Proficient computer skills with expertise in Word, Excel, and PowerPoint

Preferred Skills:

Experience in Managed Care Organizations (MCO) and Spanish language proficiency is advantageous



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