Responsibilities**This is a hybrid opportunity - the ideal candidate must be commutable to one of our residential facilities**
As a Managed Care Specialist you will provide utilization review information to insurance companies throughout the patient’s stay at Hazelden Betty Ford Foundation (HBFF) and through final payer approval process. Develops relationships with third party payers and other relevant stakeholders to promote HBFF’s clinical services and provide optimal clinical care.
- Create a client/customer focused experience for all clients/referents/customers seeking services through the Hazelden Betty Ford Foundation national system of care
- Function as an advocate for insurance and payer reimbursement for clientele utilizing substance abuse services in the Hazelden Betty Ford Foundation national system of care
- Act as a member of the multidisciplinary team by educating patients, family members, referents and other Hazelden Betty Ford Foundation staff about substance abuse, managed care, and payer medical necessity criteria
- Initiates, develops, and nurtures referent communication in order to promote an individualized relationship ensuring inclusion and participation over the span of Recovery Services
- Provide clinical case management to clients during the treatment process
- Participate in site partnership meetings in order to effectively collaborate with the clinical leaders around managed care needs.
- Effectively managing assigned caseload and tasks, including the ability to help other team members as needed.
- Provide either in-person or virtual observations and trainings on the MCS process to clinical staff at various sites across the nation.
- Support initiatives to improve clinical documentation and patient centered care with the clinical teams across the continuum.
Qualifications
Required
- Bachelor’s Degree
- Minimum 2 years’ experience in Behavioral Health Care field
- Proficiency with technology and computer skills to document in an electronic health record system, attend virtual meetings, and manage outlook emails and calendars.
- Current state licensure in Alcohol and Drug Counseling or like field (i.e. RN, LCSW, LPC, LPCC, LMFT)
- Must satisfactorily pass a state/license specific background check
Preferred
- Master’s Degree in Behavioral Health Care or related field.
- 5 years’ experience working with Insurance Products and medical necessity criteria.
Salary new (max and min)USD $74,598.00 - USD $108,703.00 /Yr.
