Program Specialist I (Social Worker)
Program Specialist I (Social Worker)
Pacer Staffing LLC
United States
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
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.
- 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 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.
- BS- Social Worker
- 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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