Job Description:

• Hours- 8:30-5:00, Monday-Friday. 1-week onsite training then Complete Remote. Will Have to Come in Periodically for Meetings/Classes As Needed. Interview Via Teams

• Provide social work assistance of varying degrees to our members.

• Our team consists of approx. 20 Case Managers

Responsibilities:

• Reviews and evaluates medical or behavioural eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions.

• Utilizes available resources to promote quality, cost effective outcomes. Provides active case management, assesses service needs, develops, and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals.

• Performs medical or behavioural review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.).

Experience:

• 4 years of clinical experience.

Certification :

• Licensed Master Social Worker/ LMSW OR Licensed Independent Social Worker/ LISW

Skills :

• Working knowledge of word processing software. Knowledge of quality improvement processes and demonstrated ability with these activities. Knowledge of contract language and application.

• Required Software and Tools: Microsoft Office. Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes. Preferred Software and Other Tools: Working knowledge of Microsoft Excel, Access, or other spreadsheet/database software.

• Work Environment: Typical office environment. Employee may work form one's/out of one's home. May involve some travel within one's community.

Education:

• Associate Degree - Nursing, OR, Graduate of Accredited School of Nursing, OR, Master's degree in Social Work (for Div. 6B or Div. 75) or Master's in Psychology, or Counselling

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.