Representative will be responsible for ensuring excellent and efficient customer service, ensuring that all covered services are authorized and placed in a timely manner, as well as provide support for all functions of the Extended MLTC as required.
RN Care Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate long-term care services for Extended MLTC members through assessment and member-centered care planning, direct provider coordination and collaboration to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes.
Physical Therapist will conduct observational assessments, provide member/caregiver education on home safety precautions, ensure proper use of assistive devices, and assess the needs of potential additional devices. Therapist will make appropriate recommendations to ensure the overall safety of the members in the home and community. Therapist will report all visits and make all recommendations to the Utilization Management Department.
Coordinator will be responsible for assisting in the transitional process to accommodate an efficient and timely start of care for perspective enrollees through the said responsibilities below. The Transitional Liaison Coordinator will receive and get guidance from the Transitional Team Leader.
Coordinator will be responsible for assisting in the transitional process to accommodate an efficient and timely start of care for perspective enrollees through the said responsibilities below. The Transitional Liaison Coordinator will receive and get guidance from the Transitional Team Leader.
Pre-screens all potential enrollee’s eligibility for MLTC services and ensures all pre-enrollment criteria are met prior to scheduling visit. Collaborates with Medicaid Specialist as needed to assist with consumer’s Medicaid eligibility.
The Utilization Nurse will be responsible for reviewing authorization requests/claims for medical necessity, under the direction and supervision of the Director of UM/Transitional Service Dept.
