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Post Acute Care Specialist – Integrated Care
CareSource. Coordinate level of care transitions and post-acute utilization management activities .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in coordinating level of care transitions and managing post-acute utilization activities, with strong communication skills to effectively liaise with stakeholders and clinical teams. Proficient in processing authorizations and eligibility verification while maintaining attention to detail and adherence to policies.
Highest-signal resume keywords
Clinical Documentation SystemsAuthorization ProcessingManaged Care ExperienceMedical Terminology CertificateCustomer Service Orientation
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ExperienceInsurance ExperiencePost-Acute Care KnowledgeEligibility VerificationData ReportingMicrosoft Office ProficiencyAttention to DetailInformation Analysis
Soft Skills
Communication SkillsCritical ThinkingProblem SolvingTeam CollaborationChange Resiliency
Certifications & Qualifications
Medical Terminology Certificate
Industry Keywords
Managed CareBehavioral Health SystemsWaiver ServicesNursing Facility ServicesClinical Review
About the role
Key responsibilities & impact- Coordinate level of care transitions and post-acute utilization management activities
- Ensure timely processing of authorization, level of care, and disenrollment requests
- Convert information from providers, members, care coordinators, waiver service coordinators, and other stakeholders into electronic records
- Verify member eligibility, provider network status, and benefit coverage
- Communicate information to appropriate team members through clinical documentation systems and other established methods
- Review requests and communicate eligibility changes, duplicate requests, and non-covered items
- Route prior authorizations and level of care reviews requiring medical necessity review by clinical staff
- Communicate with providers, care coordinators, waiver service coordinators, and other stakeholders regarding requests and outcomes
- Provide authorization, level of care, and disenrollment information to stakeholders
- Assist clinical teams in timely processing of requests requiring clinical review
- Assist clinical teams and leaders with reporting data
- Process disenrollment requests and document actions in clinical documentation systems
- Monitor workload aging and respond with appropriate urgency
- Collaborate across company departments to resolve issues and questions
- Maintain knowledge of processes and procedures for multiple markets
- Cross-train in multiple markets and products
- Follow departmental and company policies and procedures
- Perform other related duties as requested
Requirements
What you’ll need- High School or GED required
- Minimum of eighteen (18) months of clinical and/or insurance experience, or related healthcare education or certification (i.e. STNA, MA, etc.) required
- Managed care experience preferred
- Experience with post-acute, nursing facility and/or HCBS waiver services preferred
- Computer proficiency with knowledge and experience with Microsoft Office in a Windows based environment
- Ability to analyze information
- Communication skills
- Ability to work independently and within a team environment
- Attention to detail
- Proper grammar usage
- Critical listening and thinking skills
- Professional phone etiquette
- Customer service oriented
- Decision making/problem solving
- Change resiliency
- Knowledge of behavioral health systems
- Ability to accurately communicate summary information in a written format
- Medical Terminology Certificate preferred
- Flexibility to work evenings, weekends and/or holidays as needed
Benefits
Comp & perks- Bonus tied to company and individual performance may be available
- Substantial and comprehensive total rewards package
- Remote work arrangement
- Flexible schedule to work evenings, weekends and/or holidays as needed