Post Acute Care Specialist - Integrated Care
About The Position
The Post Acute Care Specialist - Integrated Care coordinates level-of-care transitions and post-acute utilization management activities to support timely processing of authorization, level-of-care, and disenrollment requests. The Specialist enters requests into clinical systems, verifies member eligibility, provider network status, and benefit coverage, and contacts providers, members, care coordinators, or other stakeholders when additional or clinical information is needed. The role communicates request details and outcomes, supports disenrollment functions and member program eligibility, and assists clinical teams with timely processing and reporting. The position requires maintaining awareness of workload aging, meeting departmental standards and goals, collaborating across company departments, and learning processes and procedures across multiple markets and products. Work takes place in a general office environment, with extended sitting or standing possible. Travel is not typically required; evening, weekend, or holiday flexibility may be needed.
Requirements
- High school diploma or GED.
- At least 18 months of clinical and/or insurance experience, or related healthcare education or certification such as STNA or MA.
- Computer proficiency and knowledge and experience with Microsoft Office in a Windows-based environment.
- Ability to analyze information and make decisions and solve problems.
- Effective communication, critical listening, and critical thinking skills.
- Ability to work independently and within a team environment.
- Attention to detail and proper grammar usage.
- Professional phone etiquette and customer-service orientation.
- Ability to adapt to change.
- Knowledge of behavioral health systems.
- Ability to accurately communicate summary information in writing.
- Flexibility to work evenings, weekends, and/or holidays as needed.
Nice To Haves
- Managed care experience.
- Experience with post-acute care, nursing facilities, and/or HCBS waiver services.
- Medical Terminology Certificate.
Responsibilities
- Convert information received from providers, members, care coordinators or care managers, waiver service coordinators, and other stakeholders into electronic records.
- Verify member eligibility, provider network status, and benefit coverage, and communicate information to appropriate team members through established processes.
- Review requests and communicate eligibility changes, duplicate requests, and items not covered by the medical benefit.
- Route prior authorizations or level-of-care reviews requiring medical necessity review to clinical staff.
- Communicate with providers, care coordinators or care managers, waiver service coordinators, and other stakeholders regarding authorization, level-of-care, and disenrollment requests and outcomes.
- Provide support to providers and share authorization, level-of-care, or disenrollment information with relevant stakeholders according to established processes or upon request.
- Assist clinical teams in ensuring requests requiring clinical review are received and processed in a timely manner.
- Assist clinical teams and leaders with gathering data for reporting.
- Process disenrollment requests in required systems and document actions in the clinical documentation system.
- Monitor workload aging and respond with appropriate urgency.
- Meet department standards and goals and collaborate across company departments to address issues and questions.
- Maintain knowledge of processes and procedures across multiple markets and cross-train in multiple markets and products.
- Adhere to departmental and company policies and procedures.
- Perform other job-related duties as requested.
Benefits
- May qualify for a bonus tied to company and individual performance.
- Substantial and comprehensive total rewards package focused on employee well-being.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
