Post-Acute Care Navigator & Authorization Specialist

CareSource; Columbus (OH); On-site; USD 41,000 - 66,000; Full time

Benefits offered by this job

Bonus potential

Job summary

CareSource in Columbus, OH seeks a Post Acute Care Specialist-Integrated Care to coordinate level of care transitions and post-acute utilization management activities. You will process requests in clinical systems, communicate with providers and members to obtain needed information, and support disenrollment and eligibility efforts.

The role requires a high school diploma or GED and at least 18 months of clinical/insurance experience or related healthcare education.

Qualifications

• High School or GED required.
• 18 months of clinical and/or insurance experience or related healthcare education/certification (e.g. STNA, MA).
• Managed care experience preferred.
• Experience with post-acute, nursing facility and/or HCBS waiver services preferred.

Responsibilities

• Convert information from providers/members/stakeholders into electronic records while verifying eligibility and benefit coverage.
• Review requests and communicate changes in eligibility and other issues to providers or stakeholders.
• Initiate routing for prior authorizations or level of care reviews requiring medical necessity review.
• Communicate with providers and stakeholders regarding prior authorization and disenrollment outcomes; provide support as needed.
• Provide authorization, level of care, or disenrollment information to providers and other stakeholders per process.
• Assist Clinical team to ensure timely processing of authorized/level of care requests.
• Assist in gathering data for reporting and document actions in the system.
• Cross-train in multiple markets and products; adhere to policies and procedures.

Skills

MS Office Proficiency

Analytical skills

Communication

Teamwork

Attention to detail

Grammar

Active listening

Phone etiquette

Customer service

Decision making

Adaptability

Behavioral health knowledge

Written communication

Education

High School or GED

Healthcare experience (18 months)

Managed care experience preferred

Post-acute/HCBS waiver exposure preferred

Medical Terminology Certificate (preferred)

Job description

CareSource in Columbus, OH seeks a Post Acute Care Specialist-Integrated Care to coordinate level of care transitions and post-acute utilization management activities. You will process requests in clinical systems, communicate with providers and members to obtain needed information, and support disenrollment and eligibility efforts.

The role requires a high school diploma or GED and at least 18 months of clinical/insurance experience or related healthcare education.