UM Clinical Services Coordinator - West Region in Cypress, CA at Beacon Health Options

Date Posted: 8/10/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic UM Clinical Services Coordinator to join our Utilization Management team in Cypress, CA! The Clinical Services Coordinator is the front line interface to Members and Providers who seek information about behavioral health benefits.  Service Coordinators assist callers by providing benefit and eligibility information and referrals to network providers.  The Service Coordinator transfers clinical calls to clinicians, as defined in the department policies and procedures.  In addition, the Service Coordinator will be responsible for completing specified assignments that assist the department in meeting contractual and or performance goals.

Position Responsibilities

  • Responds to questions about eligibility, benefits and procedures for accessing behavioral health services.
  • Verifies member benefits and eligibility through health plan computer access, phone, and e-mail.
  • Educates callers about Beacon/BCBHM services and their mental health benefits.
  • Obtains urgent, routine with assistance appointments within established time frame guidelines.
  • Verifies that member attends urgent scheduled appointment and reports outcome back to Case Manager.
  • Requests for Single Case Agreement for non-contracted providers per established guidelines.
  • Follows health plan specific contract guidelines.
  • Processes and completes Pre-Review Screenings per guidelines.
  • Coordinates with Case Manager when appropriate in understanding members’ needs.
  • Checks voice mail and return calls within 1 business day.
  • Checks e-mail to stay informed of procedures and communicate with team members.
  • Works with health plan, County entities, community agencies and providers to effectively coordinates member care.
  • Provides resources and referrals to members.
  • Consistently provides members, providers, and internal staff with exceptional customer service.
  • Utilizes Pre-Review Screening tool, makes appropriate provider referrals and/or refers to licensed clinician for clinical evaluation. 
  • Identifies complaints and assist patients to exercise grievance rights.
  • Identifies calls requiring clinical evaluation or interpretation and refer to licensed clinician.
  • Accesses to Protected Health Information, Beacon/BCBHM and Health Plan Patient Files (ledger, authorizations, and administrative, claims, and clinical notes) as needed for Referral and Authorization; Provider files as needed for Referral and Authorization.
  • Interacts with providers and payers to coordinate patient care and resolve authorization issues.
  • Interacts with clinical CM’s, claims, IP and provider relations departments in order to service callers appropriately and process reports.
  • Adheres to all Beacon policies and procedures and standards of operations.
  • Completes all required and assigned trainings.
  • Attend all mandatory company or department meetings.
  • Report to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.
  • Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
  • Performs special projects and other duties as assigned and required.

Position Requirements:

  • Education:  High School diploma or GED equivalent required, Bachelor’s Degree preferred
  • Relevant Work Experience: 2-3 years’ experience in an administrative support, customer service or similar position and /or skill set required

To Apply:

Click below on “Apply for this Position” to create a profile and apply for the position

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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