Care Authorization & Discharge Specialist II

CareSource; Arkansas; Hybrid; USD 37,000 - 59,000; Full time

Job summary

CareSource is seeking an Complex Population Service Determination Specialist II to review medical necessity and HCBS/waiver services for appropriate authorization. The role supports discharge planning, care coordination, and monitoring of services across CareSource Management Group lines.

Requires nursing license or health care degree and prior utilization review experience. Applicants should be familiar with Medicaid/Medicare and care coordination, and be able to work with providers to address

Qualifications

• RN licensed in the state or health care bachelor's degree holder.
• Prior utilization review or case management experience preferred.
• Experience with Medicaid, Medicare, commercial and managed care favorable.

Responsibilities

• Review medical necessity and HCBS/waiver services for authorization.
• Coordinate with Care Coordination and providers on discharge planning and transitions.
• Ensure compliance with state/federal regulations and NCQA standards.

Skills

RN/Healthcare degree

Care coordination

Utilization review

Education

RN or healthcare bachelor's

Tools

MCG guidelines

ASAM criteria

HCBS waivers

Job description

CareSource is seeking an Complex Population Service Determination Specialist II to review medical necessity and HCBS/waiver services for appropriate authorization. The role supports discharge planning, care coordination, and monitoring of services across CareSource Management Group lines.

Requires nursing license or health care degree and prior utilization review experience. Applicants should be familiar with Medicaid/Medicare and care coordination, and be able to work with providers to address