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LTSS Service Care Manager

Spectraforce Technologies

United States, North Carolina, Raleigh

Nov 28, 2025

Position Title: LTSS Service Care Manager

Work Location: Remote-Texas; preferably Hidalgo SDA

Assignment Duration: 6 months

Work Arrangement: Remote

Responsibilities:

Review assessments & service plans (internal assessments)
Follow up on pending assessment findings, clarify DX, reported abnormal findings, requested referrals, etc.
MN denials
- Research community resources.
2065D approval/denials
- Update LTSS
- Terminate LTSS waiver service authorizations.
- Provide community resources.
- Instruct member on appeal process and level change.
Initiate LTSS/acute services (create authorization request template)
Research complaints and provide updates to managers for complaint responses.
Escalations
- MSC call backs.
CDS review
Acute UM denials to include PT denial, request for more information.
Create clinical reviews/IRTs
CIC, CIS without MNLOC completion.
Fair hearing assistance as needed.
Determine MN for post assessment identified items.
Dental, nursing, vision, verify service utilization, 28 day follow ups.
- Verify all services have been started.
- Follow up on all non DME identified needs.
Send required referrals for new services/items identified except DME.
- Submit DME tasks for newly identified DME items.

Candidate Requirements
Education/Certification	Required: BS- Social Worker	Preferred:
Licensure	Required:	Preferred:
Years of experience required: prefer MCO experience Requires a Bachelor's degree and 2 - 4 years of related experience. Disqualifiers: Additional qualities to look for: Spanish speaking
Top 3 must-have hard skills stack-ranked by importance	1	Excellent computer skills
2	Proficient in Microsoft programs, i.e.. Word, Excel, and OneNote
3	Previous MCO experience