Oakland Community Health Network · 1 week ago
Acute Care Authorization Analyst
United States
Full-time
Remote
Entry, Mid Level
2+ years expOakland Community Health Network is seeking an Acute Care Authorization Analyst to work within the UM/UR and Crisis Departments. This role is responsible for providing clinical oversight, advocacy, and authorization for individuals being assessed for higher levels of care, ensuring effective use of resources through various reviews and compliance with regulations.
Mental Health Care
Responsibilities
Assess verification of insurance, county of financial responsibility (COFR), and ensure that acute care criteria guidelines have been met
Provide timely and comprehensive analysis of acute care initial authorizations according to established clinical protocols and diagnostic criteria
Assist individuals in accessing necessary crisis services as medically appropriate and in the least restrictive environment
Leverages clinical knowledge, business rules, regulatory guidelines, policies and procedures to determine clinical appropriateness for acute care authorizations
Support strategies to comply with state, federal, CARF, NCQA, and HEDIS regulations/initiatives
Provide support to community partners and network staff related to acute services and best practices
Determines clinical appropriateness for Specialist Reviews and Specialist Approvals
Conducts concurrent clinical case reviews as requested and provides recommendations for follow up
Conducts retrospective reviews of service provision to ensure services were provided in the appropriate amount, scope, and duration to reasonably achieve goals as outlined in the Individualized Plan of Service
Utilizes knowledge of protocols and audit tools to conduct clinical audits and ensures inter-rater reliability within timeframes outlined
Conducts retrospective reviews for acute care admissions utilizing the MCG Parity Tool and completes comprehensive reviews of acute care admissions
Reviews and contributes to the development and continuous updating of protocols, audit tools, procedures, and processes within the Utilization Management department
Additional duties as assigned
Qualification
Required
Master's degree in relevant discipline required
State of Michigan license, certification and / or registration as, Psychologist (LLP, LP), Social Worker (LMSW), Counselor (LPC), Marriage and Family Therapist (LMFT) or Nurse (RN)
For children's services - maintain/attain 24 hours annually of child-specific training (Child Diagnostic and Treatment Professional)
Minimum of two years' experience working in the human health and service field
Demonstrates effective interpersonal skills
Demonstrates ability to work effectively in a team environment
Demonstrates effective negotiation skills
Demonstrates effective written and oral communication skills
Demonstrates effective computer skills
Demonstrates effective project management/organizational skills
Demonstrates effective de-escalation and problem-solving skills
Knowledge of medically necessary criteria for acute care behavioral health treatment
Knowledge of the Michigan Mental Health Code, HIPPA, Medicaid Provider Manual
Knowledge of the clinical care process-crisis continuum (screening, crisis assessment, treatment planning, case management and continuing care)
Knowledge of the practices and principles of psychological, emotional, and social assessment and diagnosis
Must have available means of transportation to and from OCHN
All shifts are virtual
Must be available for meetings and events which may occur outside of standard office hours
The ideal candidate must be able to complete all physical requirements of the job with or without reasonable accommodation
Preferred
Experience in working with electronic health records
Prior experience working in a crisis or psychiatric hospital service environment (hospital, crisis center, community mental health agency, ACT team)
Experience with data entry
Experience working with adults with severe mental illness, substance use disorder or intellectual/developmental disabilities
Experience working with children with serious emotional disturbance
Company
Oakland Community Health Network
OCHN has a long-standing history of promoting independence, choice, and community inclusion for adults and children with intellectual / developmental disabilities, mental health concerns, and substance use disorders.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Cheryl Johnson
Chief Financial Officer
Adam Jenovai
Chief Operating Officer
Recent News
Crain's Detroit Business
2024-12-05
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