Clinical - Program Specialist (Social Worker) 1
Clinical - Program Specialist (Social Worker) 1
Pacer Staffing LLC
United States
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Job Description
Job Title: Program Specialist 1- Social Worker
Location: Remote (Mcallen Texas, 78501 Possibility to train from office for first 1-2 weeks)
Duration: 6 months (Possible extension)
Shift: Mon-Fri 8 am- 5 pm
Job Summary
Job Title: Program Specialist 1- Social Worker
Location: Remote (Mcallen Texas, 78501 Possibility to train from office for first 1-2 weeks)
Duration: 6 months (Possible extension)
Shift: Mon-Fri 8 am- 5 pm
Job Summary
- Conduct screening and risk assessment interventions per program guidelines.
- Assist with non-medical aspects of the member’s care, including referrals to community resources.
- Telehealth assessments
- Review assessments & service plans (vendor or internal assessments)
- Follow up on pending assessment findings, clarify DX, reported abnormals, requested referrals, etc.
- Hospital discharges follow up
- 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, hearing, 90 day MHM, 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.
- Review monthly audits and weekly calls to ensure we are meeting contractual requirements
- Healthy Opportunities (HOP) Eligibility & Enrollments, Benefits Eligibility Screenings, Cold Calls, Assistance in phone queue.
- Identify special needs members through the completion of health screens and other resources.
- Work with community outreach/member advocates to coordinate member care.
- Educate providers and community resources on program components and available support services.
- Educate members with special needs to foster compliance with program and positively impact outcomes.
- Conduct site visits as appropriate for programs and provide support to other special programs.
- Develop and modify care plans in conjunction with members, member’s family and managing physician.
- Development of plan specific literature and education materials in conjunction with medical director and corporate oversight
- Bachelor/master’s in social work.
- Proficient with excel/word.
- Experienced MSW/SW in a healthcare/community setting.
- Community work, experience with closing SDoH needs.
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Seniority level
Associate -
Employment type
Contract -
Job function
Health Care Provider -
Industries
Staffing and Recruiting
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