Point32Health · 21 hours ago

Behavioral Health Program Coordinator-1

Remote Worker Home Office (MA)

Full-time

Remote

Entry, Mid Level

2+ years exp

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Responsibilities

Conducts pre-clinical review validation

Reviews incoming referrals and obtains necessary demographic data.

Verifies member eligibility.

Identifies special coverage or quality events and routes appropriately.

Manages the review workflows of the department

Creates the events in the clinical system (MHK, CaseTrakker, Jiva/Ecare) as required and manages the review if indicated.

Performs basic coverage review for a defined subset of requests

Review inpatient, outpatient therapy, ABA (Applied Behavior Analysis), CBHI/BHCA (Behavioral Health Services for Children and Adolescents), psych/neuropsych testing, rTMS (Repetitive Transcranial Magnetic Stimulation) and any other level of cares, updating, requesting more information or voiding requests as applicable.

Participates in departmental operational and administrative processes such as requests for departmental information and follow up as requested.

Participates in projects and special assignments for purposes of meeting timeliness and department compliance.

May be required to represent the department on committees.

Other administrative duties and projects as assigned.

Qualification

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Managed care experienceBehavioral health knowledgeData entry proficiencyManage prioritiesConflict resolution skills