New

LTSS Service Care Manager

Spectraforce Technologies

United States, Texas, McAllen

Feb 12, 2026

Position Title: LTSS Service Care Manager

Work Location: Remote, Source from McAllen

Assignment Duration: 6 months

Work Schedule: Mon-Friday, 8 am-5 pm

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.
ISP updates (internal), 1700-3 obtain verbal approval and update form, update 1700-2 with waiver items.
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: Social Worker	Preferred:
Years of experience required: At least 2 years as social worker, Disqualifiers: Not having a BS in social work Additional qualities to look for: N/A
Top 3 must-have hard skills stack-ranked by importance	1	Computer Skills
2	Previous experience with a MCO
3	Excellent communication skills