CLINICAL SUPPORT SPECIALIST II in Wixom, MI at Beacon Health Options

Date Posted: 4/12/2018

Job Snapshot

Job Description

We are currently seeking a dynamic Clinical Support Specialist II to join our team at our office in Wixom, MI.  The regular work schedule is 11:30am-8:00pm. The Clinical Support Specialist II will assist with clinical department operations supporting Kaiser California account.

Position Responsibilities:

  • Conduct referrals, follow-up protocols, investigation of complex member/provider issues not requiring a medical necessity determination, claims issues and managing data to ensure patient and provider continuity of services.

  • Provide guidance and handle complicated inquiries related to case initiation to internal and external customers. Investigate and resolve complaints regarding claims issues or case initiation.
  • Educate providers/subscribers in the certification process and help reconcile inconsistencies and procedural difficulties. Provide support to Clinical Care Managers and Member Services and Clinical Management.
  • Initiate cases by taking data over the phone from subscribers, providers and contracted companies. Help to resolve issues and complaints from providers/subscribers needing care management services related to: referrals for treatment, authorizations for services and verification of eligibility information.
  • Oversee the administration and tracking of appeals, grievances, out of panel authorizations, single case agreements, discharges, aftercare follow-up, and administrative waivers.       Evaluates clinical appropriateness of treatment using professional knowledge within ValueOptions clinical and work site guidelines and renders certification decisions or seeks consultations for non-certification decisions.
  • Special projects and other duties including completion of surveys for depression management and mind body health solutions, with transfer to a license clinician for medical necessity determination and emergency assessment based on survey scoring.
  • All duties as assigned related to providing clinical support.

Position Requirements:

Education Requires Bachelor’s degree in Behavioral Health field (Social Work, Psychology, Counseling, Sociology or Nursing.

Licensure: N/A

Relevant Work Experience:  A minimum of two years’ experience in supporting clinical staff in a Community Mental Health setting or 5 years in Behavioral Health clinical service support environment.

Knowledge, Skills & Abilities:

  • Must have experience using management information systems, word processing, and spreadsheet applications including knowledge of Microsoft office.
  • Excellent time management, organizational skills and telephone service skills required.
  • Must demonstrate ability to maintain a professional demeanor during crisis situations.
  • Must possess an excellent work ethic, team attitude and be able to function in a multi-disciplinary team environment.
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TO APPLY

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

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