Program Specialist (Social Worker) - Full-time

Full-time Social Work Program Specialist openings in Texas with a major healthcare company! Starting ASAP!! Apply now to Jon Mahnke with A-Line!

***Must Live in Texas***

Pay Rate: $22- $26

Hours: 8:00AM - 5:00PM

Job Responsibilities:

• Telehealth biannual.
• Review assessments and service plans both vendor and internal assessments.
• Follow up on pending assessment findings, clarify diagnoses, follow up with request referrals.
• Follow up on hospital discharges.
• Medical necessity denials.
• Research community resources.
• 2065D approvals and denials.
• Update long term services and supports.
• Terminate long term services and supports and waiver service authorizations.
• Provide community resources.
• Instruct member on appeal process and level change.
• Individual Service Plan updates.
• Initiate long term services and supports and acute services.
• Research complaints and provide updates to managers for complaint responses.
• Assist with escalations and member support center call backs.
• Reviews Consumer Directed Services program with members.
• Assist with clinical reviews and authorization corrections.
• Assist with Fair Hearings as needed.
• Dental, nursing, vision, verify service utilization, hearing, 90-day MHM, 28 day follow ups; verify all services have been started and follow up on all identified needs.
• Send required referrals for new services/items identified

Why Apply:

• Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
• GREAT Hours! Monday through Friday, 40 hours per week, No Weekends
• Competitive Pay Rate!

Keywords: Healthcare, call center, mail order medications, Insurance Verification, Medicare, Medicaid, Medical billing, EOB, Benefit, Patient Service, PBM, Enrollment, Provider Services, Pharmacy, prior authorization, reimbursement counselor, Medical customer service, inbound calls, outbound calls, answer phones, make calls, medical terminology, medical office, medical claims, healthcare claims, claims processing