Program Specialist (Social Worker)
Program Specialist (Social Worker)
Pacer Staffing LLC
United States
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
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.
- 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.
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Seniority level
Associate -
Employment type
Contract -
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Staffing and Recruiting
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