Aflac · 11 hours ago
Behav Health Clinician Rev
United States
Full-time
Remote
Mid Level
$75K/yr - $90K/yr
3+ years expAflac is a Fortune 500 company and an industry leader in voluntary insurance products. They are seeking a Behavioral Health Clinician to manage behavioral health claims, provide clinical expertise, and coordinate strategies for return-to-work plans.
FinanceFinancial ServicesHealth CareInsurance
Responsibilities
Serves as clinical co-manager on behavioral health claims from inception of STD claims, and provides activities requiring clinical expertise including, but not limited to performing provider interviews, analyzing clinical information submitted, and negotiating return to work plans with employee, treating provider, and employer if applicable
Reviews and evaluates disability claims to determine level of functioning based on knowledge of behavioral health conditions, knowledge of the employer and the employee's job requirements and the plan's definition of disability
Investigates and resolves inconsistencies in the level of cognitive, emotional, or behavioral functioning
Coordinates a strategy to determine true level of functional capacity, utilizing direct contact with the treating provider and/or utilizing internal clinical resources (e.g., Peer-to-Peer Reviews, internal impairment guides, round table reviews, etc.)
Reviews claims from a behavioral health perspective to determine if clinical evidence supports preclusion from work, or the need for accommodation and/or restrictions, based on vocational demands per the applicable definition of disability
Documents impairment, functional status, and assessment, to include behavioral health, contractual, and vocational information
Acts as behavioral health consultant to the appeals business unit
Acts as resource for claims and clinical staff when handling claimants noted to be threatening harm to themselves or others
Facilitates referrals to collateral internal and external services, e.g., EAP, disease management programs, Advocacy, etc. as applicable
Monitors response to care and advocates for optimal care when applicable
Coordinates and monitors quality of behavioral health IME's
Coordinates internal physician consultant referrals, by using supporting clinical resources and vocational resources
Identifies barriers for employees to return-to-work; identifies appropriate (optimal) health care, rehabilitation, and work to facilitate an appropriate and timely return-to-work
Communicates effectively with case managers, employers, employees, and health care providers
Strategizes with claimant, treating providers, and employer on possible accommodations or restriction utilization to facilitate return-to-work
Manages daily relations with assigned accounts and key contacts
Per account requirements and upper management request, visits clients for new account implementation and maintenance of existing accounts
Attends and/or presents clinical lectures designed to educate claim staff as requested
Anticipates, recognizes, and responds timely to needs of customers to ensure customer satisfaction
Supports implementation of customer initiatives to drive best outcomes
Reviews assigned customer cases, prioritizes workload, and interprets established policies, applying discretion within authority limits to resolve customer issues
Provides status updates on co-management plans, to ensure clear communications and transparency
Resolves technical problems by referring to policies, procedures, and specifications, to ensure accuracy and operational consistency
Collects data and prepares clinical reviews, including commentary and an analysis to facilitate decision-making
Provides detailed procedural advice to internal clients, to ensure internal standards and/or procedures are adhered to related to clinical co-management
Inputs relevant data into established systems accurately to allow for data analysis
Performs additional job duties as needed
Qualification
Required
Psychiatric experience/knowledge
Solid investigative and analytical skills
Solid customer service skills
Solid written and oral communication skills
Solid organizational and time management skills
Ability to analyze behavioral health records in the context of functional capacity
Maintain active licensing and profession credentials as required
Model behaviors that demonstrate commitment to corporate values
Educate team members and business partners on area of clinical expertise
Provide guidance and support for team members
Master's Degree In Behavioral Health area or related field, e.g., MSW, MA or MS in counseling
A minimum of 3 years of experience in the field of behavioral health working with behavioral health patients
Active clinical license e.g., LCSW, LMHC, LPC, RN etc. or equivalent clinical license
Preferred
2 or more years of experience in disability management industry managing claims
CDMS or CCM designations
Utilization review experience and/or experience using specific behavioral health criteria or protocols
Benefits
Medical, dental, and vision coverage
Prescription drug coverage
Health care flexible spending
Dependent care flexible spending
Aflac supplemental policies (Accident, Cancer, Critical Illness and Hospital Indemnity offered at no costs to employee)
401(k) plans
Annual bonuses
Opportunity to purchase company stock
11 paid holidays
Up to 20 days PTO to be used for any reason
State-mandated sick leave (Washington employees accrue 1-hour sick leave for every 40 hours worked)
Other leaves of absence, if eligible, when needed to support your physical, financial, and emotional well-being
Company
Aflac
Aflac is a company that offers individuals and companies supplemental disability insurance.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
unknown1974-06-14IPO
Leadership Team
JR Shamley
SVP National Accounts Business Development & Growth Solutions
Matthew D. Owenby
SVP, Chief Human Resources Officer and Corporate Services Executive
Recent News
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