Pacer Staffing LLC

Program Specialist I (Social Worker)

Pacer Staffing LLC United States
Pacer Staffing LLC

Program Specialist I (Social Worker)

Pacer Staffing LLC United States
2 months ago 93 applicants

See who Pacer Staffing LLC has hired for this role

Title: Program Specialist I (Social Worker) one

Location: Remote only for McAllen, TX

Duration: 6 months

Shift: 8:00 am – 5:00 pm

Note

  • This position is but does require travel to team meetings a few times per year.

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.

Responsibilities

  • Telehealth assessments
  • Review assessments & service plans (vendor or internal assessments)
  • Follow up on pending assessment findings, clarify DX, reported abnormal, 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 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, 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.

Education Required

  • BS- Social Worker

Required Skills

  • Excellent computer skills
  • Proficient in Word, Excel, and PowerPoint

  • Seniority level

    Associate

  • Employment type

    Full-time

  • Job function

    Other

  • Industries

    Staffing and Recruiting

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