LTSS Care Navigator

Pyramid Consulting, Inc.; College Park (MD); Remote; USD 60,000 - 80,000; Full time

Job summary

Une entreprise de soins de santé recherchons un LTSS Care Navigator pour un contrat de 6 mois. Le rôle implique la coordination des soins, le développement de plans personnalisés et la communication avec membres. Une licence et de l'expérience en service clientèle sont essentielles pour ce poste.

Benefits

Health insurance (medical, dental, vision)

401(k) plan

Paid sick leave

Qualifications

• Licence LVN / LSW / LMSW / LCSW requise.
• Expérience de 2-4 ans dans un rôle lié.
• Connaissance des processus d'autorisation et gestion des refus.

Responsibilities

• Développe et coordonne des activités de gestion des soins.
• Élabore des plans de soins personnalisés pour les membres.
• Communique quotidiennement via des IMs de groupe.

Skills

Customer Service

Proficiency in MS Office tools

Healthcare advocacy

Education

Bachelor's in social work or related field

High School / GED

Job description

Immediate need for a talented LTSS Care Navigator. This is a 6+ months contract opportunity with long-term potential, located remotely in TX. Please review the job description below and contact me ASAP if interested.

Job ID: 25-71319

Pay Range: $20 - $21 / hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Shift Time & Working Days: 8am - 5pm, Mon to Fri, OT dependent on business needs.
• Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes.
• Develops or contributes to the development of personalized care plans for members and educates members and their families/caregivers on available services and benefits to improve healthcare access and quality care through advocacy and coordination.
• Daily check-ins & communication via group IMs.
• Complete daily production logs and email to the designated person by 9am next business day.
• Multi-tasking with multiple monitors and applications.
• Utilize work guides and resources effectively.
• Maintain 97% quality (audits) and 98% production standards.

Key Requirements and Technology Experience:

• Key Skills: LVN / LSW / LMSW / LCSW (license is most important)
• Proficiency in MS Office tools
• Customer Service experience
• Requires a bachelor's degree and 2-4 years of related experience. Clinical licensure (e.g., RN, LPN) from an accredited nursing school is preferred.
• Equivalent experience demonstrating relevant knowledge, duties, scope, and skills is acceptable.
• Current state's clinical license preferred.
• Experience with processing authorizations for DME, MHM, DAHS, and managing denials, with high efficiency (e.g., 1 business day turnaround for certain authorizations).
• Utilize project temps/contingent workers to assist with high authorization volumes and cross-training for multiple functions.
• Preferred Certifications: LPN, LVN, or LCSW.
• Education: High School / GED required; Bachelor's in social work or related field preferred.
• Licensure: LPN, LVN, or LCSW/LMSW/LBSW preferred, with license being most important.

Our client is a leading healthcare provider. We are currently interviewing for this and similar contract positions. If interested, please apply online for immediate consideration.

Pyramid Consulting, Inc. is an equal employment opportunity employer and prohibits discrimination and harassment of any kind.

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