Clinical - LTSS Service Care Manager - Axelon Services Corporation : Job Details

Location: Remote - Texas, preferably Central SDASHIFT: M - F 8am - 5PMDuration: 6+ Month contract*This is a Social Worker position. They will support the Star Plus Waiver member population. The position is remote; however, it's preferred that they are located in or near the Central SDA. Preferred work experience: Medicaid MCO.Walk me through the day-to-day responsibilities of this the role and a description of the project:

• 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.

Describe the performance expectations/metrics for this individual and their team:

• Review monthly audits and weekly calls to ensure we are meeting contractual requirements.

Job Description: Position Purpose:Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs.Education/Experience:Requires a Bachelor's degree and 2 - 4 years of related experience. Internal/External Groups with which the Candidate will interface: Required Skills/Experience: Preferred Skills/ Experience: 1. Excellent computer skills 1. Previous MCO experience 2. Proficient in Microsoft programs, i.e.. Word, Excel, and OneNote 2. 3. 3. Education Requirement: BS-Social Worker Education Preferred: