SUD Managed Care Clinical Specialist

NorthCare Network•Marquette, MI

1d•$57,387 - $85,280•Hybrid

About The Position

NorthCare Network is a Specialty Prepaid Inpatient Health Plan (PIHP) located in Marquette, Michigan and is responsible for the management and service array available to residents of Michigan’s Upper Peninsula with behavioral health needs covered by Michigan Medicaid and specialty grants for substance use disorder services. Under the supervision of the SUD Clinical Manager, this position serves as the clinical entry to services, serves as a community resource for people who are seeking services, makes eligibility and Level of Care (LOC) determinations by way of telephone screening, care coordination, and is responsible for utilization management. This position primarily serves the NorthCare SUD population. The SUD Managed Care Clinical Specialist will provide clinical screening and referral services to recipients in the NorthCare Network region. This position works closely with NorthCare Clinical Leadership, and access and eligibility staff throughout the region. This person will become an expert in benefit/insurance plans, Medicaid regulations/Michigan Medicaid Provider Manual, ASAM and medical necessity criteria, and be a clinical resource for the NorthCare Network region.

Requirements

Bachelor’s Degree in Human Services or related field required.
State of Michigan Licensure in a Human Services field preferred.
Michigan Certification Board of Addiction Professionals (MCBAP) certification preferred or required to be obtained through an approved MCBAP development plan.
Experience working in the substance use disorder field preferred.
Knowledge of addiction, treatment, and recovery processes preferred.
Knowledge of ASAM criteria, Medicaid rules and regulations, and insurance and benefit plans preferred.

Nice To Haves

Master’s Degree in Human Services or related field preferred.
State of Michigan Licensure in a Human Services field preferred.
Michigan Certification Board of Addiction Professionals (MCBAP) certification preferred or required to be obtained through an approved MCBAP development plan.
Experience working in the substance use disorder field preferred.
Knowledge of addiction, treatment, and recovery processes preferred.
Knowledge of ASAM criteria, Medicaid rules and regulations, and insurance and benefit plans preferred.

Responsibilities

Serves as the clinical entry to services
Serves as a community resource for people who are seeking services
Makes eligibility and Level of Care (LOC) determinations by way of telephone screening
Care coordination
Responsible for utilization management
Provide clinical screening and referral services to recipients in the NorthCare Network region
Become an expert in benefit/insurance plans, Medicaid regulations/Michigan Medicaid Provider Manual, ASAM and medical necessity criteria
Be a clinical resource for the NorthCare Network region