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As part of the PIRS & LOCERI team, the Health and Social Service Care Coordinator will manage level of care reviews for CCC Plus waiver members due for an annual level of care review and those with suspected changes in condition or level of care. As well as manage newly identified waiver member enrollments. The Health and Social Service Care Coordinator will work collaboratively with the designated Care Manager assigned to the identified member along with their manager.
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If you are located in Virginia, you will have the flexibility to work remotely as you take on some tough challenges.
Primary Responsibilities:
- Assign, process and submit annual, monthly, and urgent LOCERI's using the developed process
- Provide monthly reports to DMAS regarding members whose LOCERI remain incomplete and fall into a subcategory
- Process PDN, agency directed and consumer directed waiver enrollment requests
- Collaborate with assigned care coordinators, managers, UM, and providers
- Complete monthly audit reviews as directed by DMAS
- Process DMAS80s for nursing facility admissions, discharges, and level of care changes as needed
- Process Due within 60 days report monthly and compare to Annual list watching for variances
- Process overdue Comparison Report as directed by DMAS
- Other duties as assigned
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- Must meet one of the following:
- 4-year or Higher Degree in a health related field (e.g., psychology, counseling, etc.) plus 2+ years of direct experience
- Current, unrestricted independent licensure as a Social Worker
- LPN with 5+ years of direct experience
- 1+ years of experience with MS Office, including Word, Excel, and Outlook
Preferred Qualifications:
- Experience working in team-based care
- Experience working with Virginia Medicaid
- Experience working with Long-term care individuals
- Background in Managed Care
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.