Post Acute Care Specialist - Integrated Care

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

Job Summary

The Post Acute Care Specialist -Integrated Care is responsible for coordinating level of care transition and post-acute UM activities to ensure compliance with timely processing of authorization, level of care, and disenrollment requests. The Specialist processes requests into clinical systems for review, contacts the provider, member, or other stakeholder if additional and/or clinical information is required, and communicates with stakeholders to complete disenrollment functions and support members to maintain program eligibility.

Essential Functions

• Convert information obtained from providers, members, care coordinators/care managers, waiver service coordinators, or other stakeholders (received via fax, phone, provider portal or mail) into electronic records while verifying member eligibility, provider network status, and benefit coverage; communicate information to appropriate team members via established processes within the clinical documentation system or other communication methods.
• Review requests and communicate changes in eligibility , duplicate requests, and items not covered by medical benefit to providers or other stakeholders.
• Initiate process for routing prior authorizations or level of care reviews requiring medical necessity review by clinical staff.
• Communicate with providers, care coordinators/care managers, waiver service coordinators, or other stakeholders regarding prior authorization, level of care, or disenrollment requests and outcomes; provide support to providers as appropriate.
• Provide authorization, level of care, or disenrollment information to provider, facility, member, care coordinator/care manager, waiver service coordinator and/or other stakeholders per established processes or upon request.
• Assist Clinical team as directed to ensure requests for authorization or level of care that require clinical review are received and processed timely.
• Assist clinical teams and leaders in gathering data for reporting.
• Assist in processing disenrollment requests in required systems and document actions in clinical documentation system.
• Maintain awareness of current workload aging and respond with appropriate sense of urgency.
• Expectation to meet department standards and goals.
• Collaborate across company departments to assist with issues and questions.
• Maintain knowledge and understanding of all processes and procedures for multiple markets.
• Sufficiently cross-trained in multiple markets and products.
• Adhere to all departmental and company policies and procedures.
• Perform any other job related duties as requested.

Education and Experience

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

Competencies, Knowledge and Skills

• Computer proficiency with knowledge and experience with Microsoft Office in a Windows based environment
• Ability to analyze information
• Communication skills
• Ability to work independently and within a team environment
• Attention to detail
• Proper grammar usage
• Critical listening and thinking skills
• Professional phone etiquette
• Customer service oriented
• Decision making/problem solving
• Change resiliency
• Knowledge of behavioral health systems
• Ability to accurately communicate summary information in a written format

Licensure and Certification

• Medical Terminology Certificate preferred

Working Conditions

• General office environment; may be required to sit or stand for extended periods of time
• Position required the flexibility to work evenings, weekends and/or holidays, as needed
• Travel is not typically required

$41,200.00 - $66,000.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Hourly

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.