Social Worker

Houston, TX

Posted: 01/16/2023 Category: Social Worker Job Number: Smanzella116527

Job Description

(Remote) Social Work Program Specialist openings with a major health insurance / managed care company based in Texas! Starting ASAP!! Apply now with Silvana M. at A-Line!

***This position is Remote but must live in Texas as it does require travel to onsite for team meetings a few times per year***

Hours: Mon-Fri 8am-5pm
Pay Rate: $20 - $28 hourly

Responsibilities:

  • Telehealth – 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.
  • 2065D approvals and denials.
  • Update long term services and supports.
  • Terminate long term services and supports and waiver service authorizations.
  • Provide community resources.
  • 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 all services have been started and follow up on all identified needs.
  • Send required referrals for new services/items identified.

Performance Expectations/Metrics:

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


Required Skills/Experience:

  • Bachelor’s degree in Social Work
  • 2+ years of experience managing and integrating the social/community needs of members
  • Excellent computer skills; Proficient in Microsoft Systems to include Work, Excel and Teams, Outlook, Zoom, etc.

Preferred Skills/ Experience:

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


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


Keywords: Medical Necessity Review, Clinical Review, Denials, Appeals, Grievances, Medicare, Medicaid, CMS, Licensed Clinical Social Worker, Master of Social Work, Licensed Social Worker, Licensed Master Social Worker, MSW, LSW, LCSW, LMSW, Social Work, Social Worker, Medicare, Medicaid, Discharge Planning, Determination Review, Clinical Review, DSNP, Risk Assessment, Utilization Management, Utilization Review, Managed Care, MCO, Health Insurance, Health Plan, Managed Care, Care Manager, Queue Management, Case Management, Medications, Insurance Verification, Pharmacy, Prior Authorization, Medical Service, Healthcare, Inbound Calls, Outbound Calls, Medical Necessity Review, Clinical Review, Denials, Appeals, Grievances, Medicare, Medicaid, CMS, Licensed Clinical Social Worker, Master of Social Work, Licensed Social Worker, Licensed Master Social Worker, MSW, LSW, LCSW, LMSW, Social Work, Social Worker

Job Requirements

Required Skills/Experience:

  • Bachelor’s degree in Social Work
  • 2+ years of experience managing and integrating the social/community needs of members
  • Excellent computer skills; Proficient in Microsoft Systems to include Work, Excel and Teams, Outlook, Zoom, etc.
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