Managed Care Specialist

Hazelden Betty Ford Foundation•Philadelphia, PA

7h•Hybrid

About The Position

As a Managed Care Specialist, you will provide utilization review information to insurance companies throughout the patient’s stay at Hazelden Betty Ford Foundation (HBFF) and through the final payer approval process. You will develop relationships with third-party payers and other relevant stakeholders to promote HBFF’s clinical services and provide optimal clinical care. This role functions as an advocate for insurance and payer reimbursement for clientele utilizing substance abuse services within the Hazelden Betty Ford Foundation national system of care. You will act as a member of the multidisciplinary team by educating patients, family members, referents, and other Hazelden Betty Ford Foundation staff about substance abuse, managed care, and payer medical necessity criteria. You will initiate, develop, and nurture referent communication to promote an individualized relationship ensuring inclusion and participation over the span of Recovery Services. Additionally, you will provide clinical case management to clients during the treatment process, participate in site partnership meetings to effectively collaborate with clinical leaders around managed care needs, and effectively manage your assigned caseload and tasks, including the ability to help other team members as needed. You will also provide either in-person or virtual observations and trainings on the MCS process to clinical staff at various sites across the nation and support initiatives to improve clinical documentation and patient-centered care with the clinical teams across the continuum.

Requirements

Bachelor’s Degree
Minimum 2 years’ experience in Behavioral Health Care field
Proficiency with technology and computer skills to document in an electronic health record system, attend virtual meetings, and manage outlook emails and calendars.
Current state licensure in Alcohol and Drug Counseling or like field (i.e. RN, LCSW, LPC, LPCC, LMFT)
Must satisfactorily pass a state/license specific background check

Nice To Haves

Master’s Degree in Behavioral Health Care or related field.
5 years’ experience working with Insurance Products and medical necessity criteria.

Responsibilities

Provide utilization review information to insurance companies throughout the patient’s stay at Hazelden Betty Ford Foundation (HBFF) and through final payer approval process.
Develop relationships with third party payers and other relevant stakeholders to promote HBFF’s clinical services and provide optimal clinical care.
Create a client/customer focused experience for all clients/referents/customers seeking services through the Hazelden Betty Ford Foundation national system of care.
Function as an advocate for insurance and payer reimbursement for clientele utilizing substance abuse services in the Hazelden Betty Ford Foundation national system of care.
Act as a member of the multidisciplinary team by educating patients, family members, referents and other Hazelden Betty Ford Foundation staff about substance abuse, managed care, and payer medical necessity criteria.
Initiate, develop, and nurture referent communication in order to promote an individualized relationship ensuring inclusion and participation over the span of Recovery Services.
Provide clinical case management to clients during the treatment process.
Participate in site partnership meetings in order to effectively collaborate with the clinical leaders around managed care needs.
Effectively managing assigned caseload and tasks, including the ability to help other team members as needed.
Provide either in-person or virtual observations and trainings on the MCS process to clinical staff at various sites across the nation.
Support initiatives to improve clinical documentation and patient centered care with the clinical teams across the continuum.