Social Worker (BSW) - A-Line Staffing Solutions

Social Worker openings with a major health insurance company based in San Antonio, TX 78230! Starting ASAP!! Apply now with Luke H. at A-Line!

Primarily Remote; must be from Bexar County or surrounding counties; Candidate may need to conduct field visits and might have to go into office (San Antonio) for meetings and to pick up flyers for members but very rarely.

Hours: Mon - Fri from 8AM - 5PM
Pay Rate: $22 - $27 hourly plus travel reimbursement for fieldwork

Responsibilities:

• Telehealth/Face to Face Assessments as needed – annual and biannual.
• Review assessments and service plans – both vendor and internal assessments.
• Follow up on pending assessment findings, clarify diagnoses, follow up with request referrals; Follow up on hospital discharges.
• Medical necessity denials.
• Research community resources; Provide community resources.
• 2065D approvals and denials.
• Update long term services and supports; Terminate long term services and supports and waiver service authorizations.
• Instruct member on appeal process and level change.
• Individual Service Plan updates; Initiate long term services and supports and acute services.
• Research complaints and provide updates to managers for complaint responses.
• Assist with escalations and member support center call backs.
• Reviews Consumer Directed Services program with members.
• Assist with clinical reviews and authorization corrections.
• Assist with Fair Hearings as needed.
• Dental, nursing, vision, verify service utilization, hearing, 90-day MHM, 28 day follow ups; verify services have been started and follow up on all non DME identified needs.
• Send required referrals for new services/items identified except DME.

Performance Expectations/Metrics:

• Sign in daily and on time – unless previously on approved PTO; Daily log of work to be submitted; Communication is key; Be open and flexible to daily changing processes.

Required Skills/Experience:

• B.S. in Social Worker
• 2+ years of experience managing and integrating the social/community needs of members
• Excellent computer skills; Proficient in Word, Excel, and PowerPoint

Preferred Skills/ Experience:

• Experience in a managed care environment preferred
• LCSW (Licensed Certified Social Worker)

Why Apply:

• Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
• 401k after 1 year of employment: With employer match and profit sharing
• GREAT Hours! Monday through Friday, 40 hours per week
• Competitive Pay Rate

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