Position Title: LTSS Service Care Manager Work Location: Remote, Source from McAllen Assignment Duration: 6 months Work Schedule: Mon-Friday, 8 am-5 pm 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. 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. 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: Social Worker Preferred: Years of experience required: At least 2 years as social worker, Disqualifiers: Not having a BS in social work Additional qualities to look for: N/A Top 3 must-have hard skills stack-ranked by importance 1 Computer Skills 2 Previous experience with a MCO 3 Excellent communication skills Applicant Notices & Disclaimers For information on benefits, equal opportunity employment, and location-specific applicant notices, click here 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.