Integrated Care Post-Acute Transitions Specialist

CareSource Management Services LLC; Ohio; Hybrid; USD 56,000 - 91,000; Full time

Job summary

CareSource is seeking a Post Acute Care Specialist - Integrated Care in Ohio to coordinate level of care transitions and post-acute UM activities, ensuring timely processing of authorizations, level of care decisions, and disenrollment requests. You will process requests in clinical systems, contact stakeholders for missing information, and support members in maintaining program eligibility.

The role involves cross-team collaboration, data gathering for reporting, and adherence to department

Qualifications

• High School diploma or GED required; clinical/insurance experience preferred.
• 18+ months clinical and/or insurance experience or related healthcare education/certification (STNA, MA, etc.) required.
• Managed care experience preferred.

Responsibilities

• Convert information from providers/members/stakeholders into electronic records while verifying eligibility and benefit coverage.
• Communicate with providers and stakeholders regarding prior authorization, level of care, or disenrollment requests and outcomes.
• Initiate routing for prior authorizations or level of care reviews requiring medical necessity review.
• Assist clinical teams in gathering data for reporting and ensure timely processing of authorization or level of care requests.
• Cross-train across markets/products and adhere to company policies.

Skills

Microsoft Office

Analytical skills

Communication skills

Teamwork

Phone etiquette

Customer service

Written communication

Education

High School diploma or GED

Tools

Microsoft Office

Job description

CareSource is seeking a Post Acute Care Specialist - Integrated Care in Ohio to coordinate level of care transitions and post-acute UM activities, ensuring timely processing of authorizations, level of care decisions, and disenrollment requests. You will process requests in clinical systems, contact stakeholders for missing information, and support members in maintaining program eligibility.

The role involves cross-team collaboration, data gathering for reporting, and adherence to department