Point32Health · 18 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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Required
Bachelor’s Degree or equivalent relevant work experience is required.
Two plus years of experience in a business environment required.
Advanced verbal and written communication skills.
Demonstrate proficiency and accuracy in performing data entry tasks in multiple applications.
Appropriately identify urgent situations and follow the established protocol.
Has the ability to manage multiple priorities as well as possesses the initiative and judgment to operate within a politically sensitive framework.
Exhibits initiative and is self-directed and self-motivated in work performance.
Strong organizational, problem solving, and conflict resolution skills and the attention to detail necessary to act within a complex environment.
Excellent interpersonal skills.
Preferred
Managed care/health industry environment experience preferred.
Benefits
Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health
Company
Point32Health
Point32Health is a leading health & wellbeing organization, delivering an ever-better health care experience to everyone.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
SMILE Health
2023-08-08Non Equity Assistance
Leadership Team
Eileen Auen
Interim Executive Chair
K
Kristin Lewis
Chief Government & Community Affairs Officer
Recent News
Worcester Business Journal
2024-11-25
2024-10-24
2024-10-24
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