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LTSS Service Care Manager

2 weeks ago

McAllen, TX, United States Axelon Full time
Job Title: LTSS Service Care Manager
Location: Remote- Texas; preferably Hidalgo SDA
Shift: Monday- Friday 8-5; possibility for OT
Duration: 6 months, possibility to extend.

Job Description:
  • Review assessments & service plans (internal assessments)
  • Follow up on pending assessment findings, clarify DX, reported abnormal findings, requested referrals, etc.
  • 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.
  • 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, 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.
Candidate Requirements
  • Education/Certification
    • Required: BS- Social Worker
    • Preferred:
  • Licensure
    • Required:
    • Preferred:
  • Years of experience required: prefer MCO experience
  • Requires a Bachelor's degree and 2 - 4 years of related experience.
Additional qualities to look for:
  • Spanish speaking
Top 3 must-have hard skills stack-ranked by importance:
  • Excellent computer skills
  • Proficient in Microsoft programs, i.e., Word, Excel, and OneNote
  • Previous MCO experience