What are the responsibilities and job description for the Social Worker position at IMCS Group?
**Need local from Hidalgo County only**
Job Title: Clinical - LTSS Service Care Manager
Duration: 6 months Contract (Potential to Extend)
Location: Remote - Texas, Hidalgo SDA (Do require Home Visit)
Shift Type: Monday- Friday 8-5; possibility for OT
Payrate: $27-30/hr
Job Duties:
• Review assessments & service plans (internal assessments)
• Follow up on pending assessment findings, clarify DX, reported abnormal findings, requested referrals, etc.
• MN denials
o Research community resources.
• 2065D approval/denials
o Update LTSS
o Terminate LTSS waiver service authorizations.
o Provide community resources.
o Instruct member on appeal process and level change.
• Initiate LTSS/acute services (create authorization request template)
• Research complaints and provide updates to managers for complaint responses.
• Escalations
o 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, 28 day follow ups.
o Verify all services have been started.
o Follow up on all non DME identified needs.
• Send required referrals for new services/items identified except DME.
o Submit DME tasks for newly identified DME items.
Skills Required:
• Excellent computer skills
• Proficient in Microsoft programs, i.e.. Word, Excel, and OneNote
• Previous MCO experience
Education/Experience:
Requires a bachelor’s degree and 2 – 4 years of related experience. BS- Social Worker
Salary : $27 - $30