Social Services Specialist

Explains and facilitates SSI/SSDI application activities for interested and potentially eligible Medicaid members. This includes but is not limited to, evaluating, correlating and substantiating medical and comprehensive work histories through medical records, interviews and other documentation, acting as a member’s designated representative to Social Services, and coordinating additional treatment and/or specific evaluation with member’s physician to further substantiate disability.

Reports to: Director Field Care Manager

Department: LT- Care

Location: Tampa, FL

Essential Functions:

  • Interprets a variety of instructions furnished in written and oral form.
  • Applies regulatory requirements and accreditation standards to all review activity and reporting
  • Applies accepted criteria to review process and utilizes the parameters
  • Ensure quality customer service and maintain confidentiality
  • Collects information concerning eligibility, provider status, benefit coverage, coordination of benefits and subrogation
  • Inputs review data into systems
  • Retrieves and distributes faxes
  • Prepares and submit projects, reports or assignments as needed to meet department initiatives and/or objectives
  • Assist in evaluating process improvements
  • Demonstrate knowledge of medical terminology, CPT and ICD9 coding
  • Performs special projects as needed.
Additional Responsibilities:
    Candidate Education:
    • Required An Associate's Degree in Sociology, psychology, criminology, or health services
    • Required or equivalent work experience in counseling, social work, psychology, nursing, rehabilitation, criminal justice or other human services related field
    Candidate Experience:
    • Required 3 years of experience in relevant case work with government agency
    • Preferred Other Managed care experience
    Candidate Skills:
    • Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
    • Intermediate Ability to effectively present information and respond to questions from families, members, and providers
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Microsoft Excel Working knowledge of Microsoft Office Products including Outlook, Word and Excel
      • Required Intermediate Microsoft Word
      • Required Intermediate Microsoft Outlook
      • Required Intermediate Healthcare Management Systems (Generic)

        About us
        Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.