Post Acute Care Specialist – Integrated Care

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Oversee the transitions of care levels and manage post-acute utilization activities.

• Ensure prompt processing of authorization requests, care level assessments, and disenrollment applications.

• Transform information from providers, members, care coordinators, waiver service coordinators, and other stakeholders into electronic systems.

• Confirm member eligibility, provider network participation, and benefit coverage.

• Relay information to relevant team members via clinical documentation systems and other established channels.

• Assess requests and convey changes in eligibility, duplicate requests, and items not covered.

• Direct prior authorizations and care level evaluations that necessitate medical necessity reviews by clinical personnel.

• Engage with providers, care coordinators, waiver service coordinators, and other stakeholders regarding requests and their outcomes.

• Supply stakeholders with information regarding authorization, care levels, and disenrollment.

• Aid clinical teams in the efficient handling of requests that require clinical evaluations.

• Support clinical teams and leaders by providing reporting data.

• Process disenrollment requests and accurately document actions in clinical documentation systems.

• Monitor workload aging and respond with the necessary urgency.

• Collaborate across various company departments to address issues and inquiries.

• Maintain an understanding of processes and procedures across multiple markets.

• Engage in cross-training across various markets and products.

• Adhere to departmental and company policies and procedures.

• Carry out other related tasks as assigned.

⛳️ Requirements

• High School diploma or GED is required.

• A minimum of eighteen (18) months of clinical and/or insurance experience, or relevant healthcare education or certification (e.g., STNA, MA, etc.) is required.

• Experience in managed care is preferred.

• Familiarity with post-acute, nursing facility, and/or HCBS waiver services is preferred.

• Proficiency in computers, with knowledge and experience in Microsoft Office within a Windows environment.

• Ability to analyze data effectively.

• Strong communication skills.

• Capability to work independently as well as collaboratively in a team setting.

• Attention to detail is essential.

• Proper usage of grammar.

• Critical listening and analytical thinking abilities.

• Professional phone demeanor.

• Customer service-oriented attitude.

• Strong decision-making and problem-solving skills.

• Resilience to change.

• Understanding of behavioral health systems.

• Ability to succinctly communicate summary information in writing.

• Medical Terminology Certificate is preferred.

• Willingness to work evenings, weekends, and/or holidays as necessary.

🏝️ Benefits

• Bonus opportunities tied to both company and individual performance may be available.

• A substantial and comprehensive total rewards package.

• Option for remote work arrangements.

• Flexible scheduling to accommodate evening, weekend, and/or holiday work as needed.