Client Care Manager
2 weeks ago
** 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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