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Social Worker II

Public Health | Harrisburg, PA | Contract

Job Description
Social Worker II
Work Location: Harrisburg, PA

Job Summary/Description
Will report to the Division Director who oversees the monitoring process for the Community HealthChoices (CHC) Managed Care Organizations (MCOs).

Job Duties/Responsibilities/Functions (including but not limited to)
• Provides daily review and resolution of participant and provider related issues within the program.
• Liaison with Participant Operations staff on participant issues. Follows up on phone calls that are received through the participant hotline.
• Liaison with Provider Operations staff on provider issues. Follows up on phone calls that are received through the provider hotline.
• Liaison with identified points of contact within each MCO to resolve participant and provider issues.
• Participant Helpline calls
• Receive daily Participant Helpline call emails for all three MCOs
• Verify participant coverage for correct MCO
• Forward all Complaint ID’s to the respective MCO, identifying which Complaint ID’s require follow-up from the MCO and which do not require follow-up
• Develop and maintain a tracking method for all Complaint ID’s
• For complex complaints which require participant CIS record correction work with the Participant Operations enrollment team
• Provide Participant Operations Helpline staff routine updates of Complaint ID statuses, whether open or resolved
• Notify Monitoring Team of any issues that require follow-up with MCOs
• Participant /emails received by OLTL
• Accept emails and gather initial information
• Verify ID, participant MA coverage and MCO assignment
• Work with monitoring team, other OLTL bureaus, and/or MCO liaison on the issue(s)
• Track the issues and any follow-up
• Provider emails – mostly about provider payment issues
• Accept emails and gather initial information
• Forward the issue to the MCO for resolution
• Work with monitoring team, other OLTL bureaus, and/or MCO liaison on the issue(s)
• Track the issues and any follow-up
• Medicaid Research Center (MRC) emails
• Receive MRC emails for all three MCOs
• Verify participant coverage for correct MCO
• Forward all MRC emails to the respective MCO and request follow-up
• Develop and maintain a tracking method for all MRC emails
• For complex complaints which require participant CIS record correction work with the Participant Operations enrollment team
• Copy Participant Operations staff person responsible for the MRC emails on all correspondence
• Notify Monitoring Team of any issues that require extensive follow-up with MCOs
• Respond to calls and emails from Legislative Affairs about participant and provider related issues
• Respond and work with staff on complex cases
• Attend meetings as necessary
• Complete all necessary reports and data
• Performs other duties as assigned.

Minimum Qualifications
• Bachelor of Social Work from an Accredited Social Work Program, required.
• Basic computer skills to include, but not limited to, Microsoft Office Products, required.

About InGenesis
InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.

EEOC Statement
We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.