UM Clinical Support Coordinator - Northeast Region in Woburn, MA at Beacon Health Options

Date Posted: 10/5/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic Clinical Support Coordinator to join our Utilization Management team at our office in Woburn, MA!  The Clinical Support Coordinator is charged with tracking all outpatient reviews and sending and receiving correspondence as they relate to the outpatient department.

Position Responsibilities:

  • Make daily provider notification calls for new authorizations  and denials for NY, both provider and member (three attempts) 
  • Support the Clinical (outpatient) department in all administrative duties:
    • Data entry of provider Outpatient Review Forms and Continuing Day Treatment forms in both Flex Care and Connects
    • Extending and fixing authorizations
    • Data entry of psychological testing and other administrative forms into the system
    • Answer provider and member calls and respond to inquiries
    • Receives appeal requests and creates administrative denials for all outpatient services
    • Initiates out of network process by sending appropriate paperwork, if appeal in OON
    • Create and send manual authorization letters in cases where provider set up does not allow system authorization  (in order to meet timeliness requirements)
  • Manage incoming faxes, adding note of receipt in FlexCare, and distributing to intended recipient.
  • Assist in Out of Network process as needed
    • Process new requests
    • Create inquiries to send to shared services
    • Receive information on completes SCAs and entering authorizations
    • Work with outpatient clinical team to facilitate Out of Network process
    • Provide in network referrals to reduce Out of Network requests
    • Maintain reportable information regarding OON requests
  • Serve as a backup support for other administrative duties within the Clinical Administrative Department
  • Other duties as assigned 

Position Requirements:

  • Education: High School Diploma or GED required, Bachelor’s degree preferred
  • Relevant Work Experience: 1-2 years behavioral health required
  • Knowledge, Skills & Abilities: excellent communication skill required

To Apply:

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

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disable