Behavioral Health Absence Specialist

UPMC

About The Position

This position will focus on behavioral health disability case management activities for WorkPartners Absence Management area. As needed to ensure adequate caseload, this position will also deal with minor medical disability cases.

Requirements

Independently Licensed Mental Health Specialist (License Professional Counselor or Licensed Psychologist, Licensed Clinical Social Worker or Licensed Family and Marital Therapist) with current licensure (equivalent professional and educational experience will be considered) required. Active license strongly preferred.
Minimum of two (2) years' experience in a clinical case management role or conducting evidenced based psychotherapy required.
Ability to interact with physicians and other health care professionals in a professional manner required.
Excellent verbal and written communication and interpersonal skills required.
Excellent organizational and communication skills required.
Computer skills/literacy a must.
Ability to work independently and with various departments/personnel while managing the case.

Nice To Haves

Prior absence experience preferred.
Previous disability case management experience is preferred.
Knowledge of Employee Retirement Income Security Act of 1974 (ERISA) preferred.
Knowledge of client leave policies, federal and state leave laws pertaining to leave of absence preferred.
Certification in Case Management or Certified Disability Management Specialist preferred.

Responsibilities

Advises employees, employee's family members, managers and HR Professionals on leave and disability policies and processes.
Coordinates the leave process; verifies eligibility, determines leave and disability approvals, calculates leave length, coordinates the applicable client leaves including integration with state leave laws, monitors maximum duration of leave allowed under federal/state and/or client policy, and supports the return-to-work process
Applies concepts and rules as mandated by guidelines for FMLA, ERISA and other federally or state mandated or company specific policies.
Answers and addresses employees leave related questions, concerns in a timely manner.
Conducts interview telephonically with employees applying for a disability to collect provider information, treatment plan and employees current level of functioning
Contacts providers (telephonically, via fax) to collect and or clarify medical information needed to support a disability claim
Collaborates with health care providers and ill/injured employees to update the status of treatment plan and length of disability.
Reviews medical information submitted on behalf of the employee, job description and summary plan description to make a disability claim determination
Monitors employee's care and progress during a disability by reviewing medical documentation from employee and/or employee's treating provider to document the employee's continued absence and maintain updated medical records
Assists disability specialists on complex cases with behavioral health comorbidities and assists with making claims decisions.
Uses system workflow to manage case activities in a timely manner
Completes all case activities in case notes
Interacts with business partners telephonically, via email and instant messaging
Works with Clinical Case Mangers and Physician Consultants to review complex/questionable claims
Participates in a multidisciplinary team to Identify and refer to UPMC clinical resources community resources to address factors that impact return to work
Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and employee.
Responsible for resolving issues by interacting with employee's manager, Human Resources, payroll, or disability specialists.