Pueblo CMA Coordinator PAR chez THE RESOURCE EXCHANGE

Description

Join a Winning Team at One of Colorado's Best Workplaces!
 
The Resource Exchange (TRE)
At TRE, we don't just provide services – we transform lives. Our commitment to empowering individuals and creating inclusive communities has earned us recognition as one of Colorado’s top employers for five consecutive years. But don't just take our word for it:
"The standard of work and the culture of providing excellent service is something I’m proud to be a part of." Current TRE Staff Member, November 2024
 
Why TRE is the Place for You:
• Make an Impact: Advocate for and empower people of all ages and abilities, from infants to seniors, creating lasting change through collaboration with families, communities, and partners.
• Work with Purpose: As part of a dedicated team, you’ll help strengthen families and promote inclusion in communities across El Paso, Pueblo, Teller, and Park counties.
• Enjoy a Positive Work Environment: Join a culture that’s consistently recognized as one of the Best Workplaces in Colorado.
Who We Are:
At The Resource Exchange, we pride ourselves on being a team of over 400 passionate and talented staff who serve more than 12,000 individuals. From those with disabilities and mental health challenges to those in need of long-term care, we provide person-centered support focused on independence, inclusion, and collaboration.
What We Offer:
• Comprehensive Benefits: Health, dental, vision, Lifestyle Spending Account for health and wellness, plus pet insurance for your furry friends
• True Flexibility: Flexible work schedules to fit your life (yes, we really mean it!).
• Half-Day Fridays: Start your weekends early, every week!
• Generous Time Off: Paid Time Off with your birthday off, paid holidays, and time to celebrate what matters most to you.
• Public Student Loan Forgiveness: We're invested in your future.
• Volunteer Opportunities: Paid time off to give back to the community.
• Growth & Development: Leadership, career advancement, and workgroup opportunities to help you thrive.
Come thrive with us! At TRE, your passion for service will be recognized, and you'll be part of a culture that celebrates making a difference.
Ready to join one of Colorado’s Best Workplaces? Apply today

Qualifications

THE RESOURCE EXCHANGE

Job Description

Position Title: Pueblo  Par (Prior Authorization Request) Coordinator

Department: CMA – Adult Services

Reports to: PAR Supervisor
FLSA Status: Non-Exempt
Supervisor Responsibilities: No
Starting Range: $22.32 – $23.18 hourly (Rates are subject to change; contact [email protected] to confirm current rates.)

Benefits Offered: Health, dental, vision, employer-paid life and short-term disability, voluntary life and long-term disability, paid time off, holiday pay, 401K with employer contributions, pet insurance, other supplemental insurance options, flexible work environment, training and growth opportunities, public student loan forgiveness, mileage reimbursement, and more.

General Description:

The CMA Coordinator – Prior Authorization Request (PAR) is responsible for preparing, reviewing, and submitting Prior Authorization Requests (PARs) for Long-Term Services and Supports (LTSS) in accordance with the Colorado Department of Health Care Policy and Financing (HCPF) Rules and Regulations, including 10 CCR 2505-10 and 10 CCR 2505-8. This includes ensuring compliance with all Medicaid waiver requirements, submission timelines, documentation standards, and regulatory expectations.

The Coordinator supports accuracy in PAR submission, collaborates with stakeholders such as Provider Approved Service Agencies (PASAs), Service Coordinators, and HCPF, and ensures thorough documentation in state-approved data systems. The position is critical to maintaining compliance, reducing denials, and ensuring continuity of care for individuals receiving waiver services.

Essential Duties and Responsibilities:

• Regulatory Compliance and Documentation:
  • Ensure all PARs comply with HCPF rules, Medicaid requirements, and applicable waiver service standards.
  • Submit initial, revision, and continued stay PARs in accordance with HCPF timelines.
  • Review case files, assessments, and care plans for accuracy, medical necessity, and eligibility.
  • Maintain compliance with audit and utilization review requirements.
• Communication and Collaboration:
  • Partner with PASAs, Service Coordinators, families, and HCPF to ensure accurate and timely PARs.
  • Provide clear and constructive feedback when documentation is incomplete or misaligned.
  • Respond to and resolve discrepancies or denials with urgency and professionalism.
• Data Management and Technology Use:
  • Accurately document all activities in required data systems such as BUS, MMIS, CCM, Bridge, and other case management systems.
  • Maintain up-to-date tracking logs for each submitted, pending, or revised PAR.
  • Ensure all records are complete and in compliance with HIPAA and state regulations.
• Training and Continuous Improvement:
  • Stay informed on HCPF Policy and Operational Memos, billing code updates, and system changes.
  • Participate in required trainings and implement procedural updates into practice.
  • Ensure adherence to Case Management Redesign protocols, timelines, and documentation expectations.
• Service and Advocacy:
  • Promote person-centered planning and maintain a commitment to high-quality service delivery.
  • Advocate for participants’ access to services by ensuring proper and timely PAR processing.
  • Practice cultural humility, trauma-informed approaches, and accessibility in all communication.

Other Duties and Responsibilities:

• Provide back-up coverage for team members as needed to ensure service continuity.
• Participate in goal setting and professional development activities aligned with TRE values.
• Adapt to changes in Medicaid policy, case management redesign, and other state-level shifts.
• Perform additional duties as assigned in support of TRE’s mission and compliance standards.

Job Qualifications:

Knowledge, Skills, and Abilities:

• Knowledge of Medicaid LTSS programs, waiver services, and prior authorization processes.
• Excellent organization, time management, and prioritization skills.
• Strong understanding of electronic systems used in Colorado case management.
• Detail-oriented with critical thinking and analytical skills.
• Effective communication skills and cultural competency.
• Ability to adapt to evolving regulations and complex administrative requirements.

Education and Experience Requirements:

Minimum: Bachelor’s degree in a human behavioral science field or equivalent combination of education and LTSS-related experience.

Preferred: Experience working with individuals with disabilities, Medicaid waivers, or in a case management setting. Familiarity with HCPF systems and Colorado Medicaid policy is a plus.

Tools and Equipment Used:

Computers/tablets, cloud-based systems, printers, telephones, personal vehicles, etc.

Working Environment/Physical Activities:

Work is performed in a variety of settings including office, home, virtual, and community locations. Moderate physical activity such as walking, sitting, standing, and occasional lifting (up to 20 lbs) is required. A valid Colorado driver’s license (unless exempt due to military status), reliable personal transportation, and minimum insurance coverage of $100,000/$300,000/$100,000 are required.

This job description is not intended to be an exhaustive list of all duties responsibilities or qualifications associated with this job. Therefore, The Resource Exchange reserves the right to amend and/or modify this job description at any time and provide job specific expectations for specific Service Coordinator tasks. The Resource Exchange also reserves the right to stipulate hours of employment; work schedules may be changed to respond to business requirements.

The Resource Exchange is committed to affording an equal employment opportunity to qualified individuals regardless of their race, color, religion, national origin, sex, sexual orientation, gender expression, gender identity, age, height, weight, disability status, veteran status, military obligations, and marital status. We are also committed to conforming with the content and spirit of applicable Equal Opportunity and Affirmative Action laws and regulations. This policy applies to recruiting, hiring, training, education, promotion, compensation, benefits, termination, and all other privileges, terms, and conditions of employment.

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Employee Signature                                                                  Date