LTSS Care Navigator

Immediate need for a talented LTSS Care Navigator. This is a 06+months contract opportunity with long-term potential and is located in TX(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-71319

Pay Range: $20 - $21/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Shift Time & Working Days: 8am 5pm, Mon to Fri, OT dependent on business needs.
• Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes.
• Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.
• Daily check in & communication via group IM(s).
• Daily production logs must be completed and emailed to designated person no later than 9am next business day.
• Multi-tasking with multiple monitors and applications.
• Utilize work guides and or resources .
• 97% Quality (Audits) .
• 98% Production .
• 0-5% Error Rate .

Key Requirements and Technology Experience:

• Key Skills: LVN/LSW/LMSW/LCSW (License is the most important)
• MS Office tools
• Customer Service
• Requires a bachelor s degree and 2 4 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure.
• Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
• License/Certification: Current state s clinical license preferred.
• The Specialty Authorization Team consists of the processing of authorizations and follow-ups for DME, MHM, DAHS, and reductions/denials in which we are now at a 1 BD TAT for the processing of SK/SH/MMP authorizations.
• We utilize project temps/contingent workers to assist with each of these areas as well as cross train them to be able to assist in multiple functions.
• The team continues to experience high authorization volumes.
• Required Certifications: LPN, LVN or LCSW preferred.
• Bachelor s degree in social work, Health Services, Behavioral Science, or related field, or equivalent experience.
• 2+ years of experience in a managed care environment or working with people who have disabilities and/or with vulnerable populations who have chronic or complex conditions. Other state specific requirements may apply.
• Education/Certification Required: High School/GED.
• Preferred: Bachelor s degree in social work or related field.
• Licensure Required: LPN, LVN, or LCSW/LMSW/LBSW preferred. License is the most important.

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy .