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Behavior Health- Licensed Social Worker

Location: Cheyenne
Posted on: June 5, 2021

Job Description:

Job Description

1. Utilizing MCG, ASAM and State Specific guidelines to process incoming behavioral health Outpatient services/procedures and Inpatient stay requests to determine medical necessity and authorize units/days as appropriate.
2. Making changes/corrections to behavioral health Outpatient and Inpatient request as appropriate when requested by the provider/facility
3. Communicate with the medical director, when appropriate. if requests do not meet medical necessity guidelines.
4. Processing and documenting each review in the documentation system (Aerial) utilizing appropriate templates and following QRGs
5. Attend team meetings
6. Participating in monthly peer chart audits
What software skills are needed? Word, Excel, Outlook. Need to be detail oriented to ensure no spelling/grammar mistakes.
What are the hours? ( Training hours?) Monday-Friday 8am-5pm Mountain Time Position is remote!
Will you be interviewing (Teams or phone) Yes, our clinical manager will be interviewing over the phone.

Position Description: Collect case specific member information, review and certify the medical necessity of prospective, concurrent, and retrospective units of behavioral health inpatient and outpatient services. Review each case and determine the most appropriate services, the most appropriate setting in which the services should be delivered, the most cost efficient methods for delivery of care. Providing clinical and managed care expertise, as well as Medical Director/physician consultation when appropriate. Provide first level clinical review for all behavioral health inpatient and outpatient services requiring authorization. Evaluation for referral to Health Management. Answer telephone calls promptly as scheduled and as needed. Demonstrate adequate competence in computer software use in daily activities. Review case-specific patient information concurrently for the medical necessity of behavioral health hospital admissions using MCG, ASAM, and State specific review criteria. The behavioral health reviewer will assign the appropriate LOS days/ visits/ services in review of the clinical information obtained. Document review using appropriate note templates. Ensure timely notification of all parties (telephonic and/or written), as necessary, regarding certification determinations. Prepare case files for physician review via Physician Consultant Services or Medical director. This includes preparation of clinical information; correspondence. Function as a member of a self-directed team to meet specific individual and team performance metrics. Telephonic discussions with health care providers to explain medical necessity determinations and to obtain additional clinical information. Ensure consistent application of the utilization review process for all functional components. Document case review findings, actions, and outcomes in accordance with policy. Participate in special projects, as needed. Participate in team meetings. Manage workload to ensure timely processing per URAC, NCQA, as well as state and federal mandates. Other duties as assigned. Qualifications include: Active behavioral health license or RN license; minimum of 3 year clinical experience either in an inpatient or outpatient capacity. Previous Utilization Management experience highly preferred. Sound clinical judgment. Demonstrated understanding of managed care concepts, Strong problem solving and decision making skills, Strong departmental team player, Good written and verbal communication skills, Personal computer skills, Strong time management and prioritization skills, Excellent customer service skills including a sense of urgency and ownership for resolving issues, Strong interpersonal skills at an individual and team level, Ability to be flexible, adjust quickly and react positively to change, Knowledge of ICD-10 and CPT coding preferred. Positive attitude and good work ethics.

Company Description

Allmed is a National Staffing and Recruiting company offering short and long term staffing solutions. We have supplied staffing solutions for providers and managed care organizations throughout the United States since 2003. We work with public and private firms seeking innovative, effective solutions for short and long term staffing strategies that works specifically for them.

Keywords: ALLMED STAFFING INC, Cheyenne , Behavior Health- Licensed Social Worker, Other , Cheyenne, Wyoming

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