Job Description
The REMOTE Strategic Outpatient Engagement & Management (STEM) Care Advocate will join a team of 50+ Care Advocates across the nation to complete telephonic clinical reviews directly with Providers to ensure members are getting the most effective and efficient care promoting best practices in the Outpatient psychotherapy and community based treatment setting.
Primary Responsibilities:
* Focus on outpatient Medicaid and Medicare behavioral health services
* Complete 10-12 telephonic reviews per day in a queue-based call center environment
* Conducting outpatient utilization reviews to determine appropriate care
* Assessing if member care meets coverage guidelines, Claims research and understanding
* Provider facing; treatment review completion, Shaping member treatment in partnership with providers to ensure best practices
* Administering benefits and reviewing treatment plans, Treatment plan shaping to best practices
* Coordinating benefits and transitions between various areas of care, Market-specific recommendations
Required Skills & Experience
* Active, unrestricted Licensed Master's Degree - Independent Level Clinician in Psychology, Social Work, Counseling or Marriage or Family Counseling (LMFT, LICSW, LCSW, LPC, LPCC, LCPC)
* 3+ years in Behavioral Health field
* Willing to work: 8:30-5 PST, 9:30-6 MST,10:30-7 CST, 9:30-6 EST
* Outpatient/IOP psychotherapy and community based treatment experience
* Ability to talk on the phone and type at the same time/MS Office proficiency (Word, Excel, Outlook, Internet)
Nice to Have Skills & Experience
* Demonstrated telephonic queue/call center experience
*Experience in managed care organization/MCO highly preferred
* Utilization review/management experience, conducting clinical review to determine appropriate levels of care
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.