Offer summary

Qualifications:

LMSW or LCSW license in New York is required., Experience in care/case management and disenrollment processes is essential., Strong critical thinking and problem-solving skills are necessary., Proficiency in administrative systems and strong Excel skills are preferred..

Key responsabilities:

Evaluate disenrollment requests for compliance with regulations and policies.

Apply clinical judgment to assess the validity of disenrollment requests.

Communicate with internal teams and external facilities to facilitate disenrollment procedures.

Monitor and track disenrollment cases, reporting non-compliance for process improvement.

Job description

Job Title: Clinical Disenrollment Specialist
Location: Tri-State Area (NY, NJ) – 100% Remote
Salary Range: $37–$40 per hour

4 Corner Resources is seeking an experienced Clinical Disenrollment Specialist to join our team. This role is ideal for professionals holding an LMSW or LCSW license in New York who have a strong background in care/case management, compliance, and disenrollment processes. As a Clinical Disenrollment Specialist, you will play a crucial role in ensuring regulatory compliance while processing disenrollment requests in a fast-paced, remote environment. If you are detail-oriented, skilled in critical thinking, and eager to contribute to a mission-driven organization, this position is for you!

Required Skills & Qualifications:

LMSW or LCSW (New York License – MUST HAVE)
Experience in care/case management, disenrollment processes, and regulatory compliance
Strong critical thinking and problem-solving skills
Ability to work independently and meet quick turnaround times
Familiarity with state reporting requirements for disenrollment cases
Proficiency in administrative systems, including TruCare, ePACES, MHS, and CMS
Strong Excel skills (editing, searching, sorting/filtering data)

Preferred Skills & Qualifications:

Experience in home care, health plans, or managed care organizations (MCOs)
Bilingual (preferred but not required)
Experience managing electronic medical records in a paperless environment
Prior experience as a Care Manager or in a similar clinical administrative role
Ability to multi-task, navigate multiple systems, and work under tight deadlines

Day-to-Day Responsibilities:

Evaluate disenrollment requests to ensure compliance with state regulations and internal policies
Apply clinical judgment to assess the validity of disenrollment requests
Review and validate documentation, including UAS assessments, care plans, and medical authorizations
Ensure timely processing of disenrollments within a 24-hour timeframe
Communicate with internal teams, clinical staff, external facilities, and vendors to facilitate safe and compliant disenrollment procedures
Monitor and track disenrollment cases, identifying areas of non-compliance and reporting to care managers for process improvement
Update authorizations and records to reflect exit dates
Engage with members and their representatives to provide updates on disenrollment status and address concerns
Utilize TruCare, PEGA, MHS, ePACES, and CMS to manage and track cases efficiently
Perform additional duties as assigned

Company Benefits & Culture:

Competitive hourly pay with potential for contract extension or permanent placement
Full-time, Monday–Friday schedule (Choice of 9:00 AM–5:30 PM or 8:30 AM–5:00 PM)
Work in a dynamic, mission-driven environment that values teamwork and compliance excellence
Opportunities for professional development and career growth

4CR3

Required profile