Job Description

Location: Health Choice Management Co.
Posted Date: 6/9/2020

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.

Responsibilities:

  • 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

Education:

  • This position requires a Master’s degree in a behavioral health field, Registered Nurse or an equivalent combination of education and experience sufficient to successfully perform the essential duties of this position. This position also requires an independent behavioral health license for the state of Arizona.

Years of Experience:

  • 2 Years of experience in children and adolescent behavioral health field.
  • Preferred experience with TFC/HCTC system.
  • Preferred experience with prior authorization and concurrent review process.

Specialized Knowledge:

  • Knowledge of AHCCCS health behavioral health systems; child psychiatric diagnoses, child psychiatric medications and standards of care and medical necessity criteria.

Skills & Abilities:

  • Strong interpersonal skills.
  • Critical thinking, ability to make independent decisions and refer to others as necessary.
  • Understanding of medical records and UR systems.
  • Ability to type 35 word per minute.
  • Excellent computer skills navigating various systems/platforms and skills using Microsoft Office Suite
  • Excellent writing and documentation skills and customer service.

This is a remote position

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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