Behavioral Health Medical Management Specialist
Position Purpose: Proactively monitors the utilization of child and adolescent behavioral health services including Therapeutic Foster Care, Behavioral Health Inpatient Facilities, Behavioral Health Residential Facilities, and Inpatient facilities. Responsibilities include prior and concurrent review, quality of care review, care coordination, and discharge planning.
- Primarily conducts prior authorization and concurrent review of Therapeutic Foster Care (TFC). Provides back up coverage for other levels of care as needed.
- Processes request within required time frames.
- Identifies appropriate benefits and eligibility for requested treatment.
- Assists with locating TFC and other behavioral health resources.
- Assesses post discharge needs and coordinates services.
- Refers members to care management and disease management programs.
- Maintains accurate clinical documentation of authorizations, case management, concurrent review and discharge.
- Serves as subject matter expert for therapeutic foster care and as a resource for program specialties, including cultural appropriateness. Provides support and technical assistance to Health Choice and network of care providers.
- Consults with Medical Director when requests require MD review and/or input.
Education / Experience / Other Requirements
Years of Experience:
Skills & Abilities:
This is a remote position
Job Status: Full Time
Job Reference #: 29373