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Form of workOverview
The Clinical Services Associate supports care management and utilization of services for members. Works in collaboration with Care Teams to ensure that authorizations for services are completed correctly and comprehensively. This position is critical in the Delivery and provision of covered services and the correct payment of claims for those services
Responsibilities Communicates with Care Team personnel to receive the required information regarding needed authorizations Completes the authorizations in TruChart for new service requests and continued authorizations. Reviews each authorizaon for accuracy in start and end dates, correct service codes, diagnosis codes, numbers of units and correct providers. Ensures that authorizations are correctly faxed to the correct vendor/provider. Authorizations for DME, Supplies, Home Delivered Meals, Social & environmental Items and PERS will be completed and tracked by Clinical Services Associate (CSR). Ensures that all authorizations for each member end on the same day of the authorization period, regardless of the start date. (i.e.: if a request for a service occurs in the middle of an authorization period, it must be created until the end of the authorization period. This date range is based upon the enrollment date/start of service. (PERS installation authorizations are to be created for one month and PERS monitoring authorizations are created for 6 months or the end of the authorization period. Modifies authorizations for PCA when member is hospitalized. UM MSR modifies the number of units until admission date. CSR will create a new authorization (with an end date from the original authorization) to re-instate the services. The same process will be followed for members temporarily outaofaarea, in shortaterm rehab or respite. Participates in QAPI initiatives within ArchCare Senior Life. Performs other related dues, as required.Qualifications Education Requirements Associate's Degree in Health or Human Services or related field.Education Desired Bachelor's Degree in health related field preferred.Experience Requirements Minimum 1 year experience working with frail and elderly population and 2 years minimum relevant work experience Demonstrated skills in planning, organizing and directing the work of others required. Ability to deal with cognitively impaired frail elderly required.Employment Type: FULL_TIME
