Pacer Staffing LLC

Program Specialist (Social Worker)

Pacer Staffing LLC United States
Pacer Staffing LLC

Program Specialist (Social Worker)

Pacer Staffing LLC United States
2 months ago 111 applicants

See who Pacer Staffing LLC has hired for this role

Job Title: Program Specialist (Social Worker)

Location: Remote in TX

Duration: 6 Months (Possible Extension)

Shift: 8:00am – 5:00pm (Monday - Friday)

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.
  • Job Responsibilities:
  • Identify special needs members through the completion of health screens and other resources Collaborate 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.

Education/Experience

  • Bachelor’s degree in Social Work, Nursing, Health, Behavioral Science or Equivalent Experience.
  • Experience in a managed care environment preferred. 0-2 years of experience
  • 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 members 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 is 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.

  • Seniority level

    Associate

  • Employment type

    Contract

  • Job function

    Other

  • Industries

    Staffing and Recruiting

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