Post Acute Care Specialist – Integrated Care

🔥 54 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $41.2k - $66k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Coordinate level of care transitions and post-acute utilization management activities • Ensure timely processing of authorization, level of care, and disenrollment requests • Convert information from providers, members, care coordinators, waiver service coordinators, and other stakeholders into electronic records • Verify member eligibility, provider network status, and benefit coverage • Communicate information to appropriate team members through clinical documentation systems and other established methods • Review requests and communicate eligibility changes, duplicate requests, and non-covered items • Route prior authorizations and level of care reviews requiring medical necessity review by clinical staff • Communicate with providers, care coordinators, waiver service coordinators, and other stakeholders regarding requests and outcomes • Provide authorization, level of care, and disenrollment information to stakeholders • Assist clinical teams in timely processing of requests requiring clinical review • Assist clinical teams and leaders with reporting data • Process disenrollment requests and document actions in clinical documentation systems • Monitor workload aging and respond with appropriate urgency • Collaborate across company departments to resolve issues and questions • Maintain knowledge of processes and procedures for multiple markets • Cross-train in multiple markets and products • Follow departmental and company policies and procedures • Perform other related duties as requested

🎯 Requirements

• High School or GED required • Minimum of eighteen (18) months of clinical and/or insurance experience, or 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 • 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 • Medical Terminology Certificate preferred • Flexibility to work evenings, weekends and/or holidays as needed

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Remote work arrangement • Flexible schedule to work evenings, weekends and/or holidays as needed

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