Job Description

Location: Health Choice Management Co.
Posted Date: 10/27/2020

Position Purpose:

The Medical Management Specialist is responsible for completing prior authorization and concurrent reviews for behavioral health services by uutilizing pre-approved criteria and guidelines to validate medical necessity. Medical Management Specialist also reviews appropriateness of discharge planning; coordinates discharge planning with outpatient providers; issues Notices of Actions and participates in clinical rounds.

Responsibilities:

  • Conducts prior authorization and concurrent reviews.
  • Assessment of post discharge needs and coordinates of services.
  • Refers members to care management and disease management programs.
  • Completes Notices of Action or Notices of Decision and maintains accurate clinical documentation of authorizations, case management, concurrent review and discharge.
  • Serves as subject matter expert for behavioral health services, and as a resource for program specialist, including cultural appropriateness. Provides support and technical assistance to HCA and HCA network of care providers based on the needs of the members or of a specific provider
  • Consults with Medical Director as needed to review complex cases

Education / Experience / Other Requirements

Education:

  • Requires a Master’s degree in a behavioral health field, Registered Nurse
  • Or an equivalent combination of education and experience sufficient to successfully perform the essential duties of this position
  • Requires an independent behavioral health license for the state of Arizona.

Years of Experience:

  • 2 Years of experience in behavioral health field.
  • Preferred experience with prior authorization and concurrent review process.

Specialized Knowledge:

  • Arizona Medicaid system and behavioral and AHCCCS health systems
  • Psychiatric diagnoses, psychiatric medications and standards of care
  • Medical necessity criteria
  • Managed care principles
  • Ability to prioritize and effectively handle multiple projects
  • Communicate effectively both verbally and in writing
  • Use of a variety of computer-based technologies including Microsoft Office applications
  • Ability to work effectively and efficiently as a team member or independently.

Skills & Abilities:

Strong interpersonal skills.

• Critical thinking, ability to make independent decisions and refer to others as necessary.

• Understanding of medical records and UR systems.

• Ability to type 35 word per minute.

• Excellent computer skills navigating various systems/platforms and skills using Microsoft Office Suite

• Excellent writing and documentation skills and customer service.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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