Position Title: LTSS Service Care Manager 
Work Location: Remote-Texas; preferably Hidalgo SDA
Assignment Duration: 6 months
Work Arrangement: Remote

Responsibilities:

• 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. Disqualifiers:   Additional qualities to look for: Spanish speaking
  Top 3 must-have hard skills stack-ranked by importance		1	Excellent computer skills
  		2	Proficient in Microsoft programs, i.e.. Word, Excel, and OneNote
  		3	Previous MCO experience

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 28.00/hr.