Behavioral Health Medical Management Specialist
Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.
Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!
The Medical Management Specialist is responsible for completing prior authorization and concurrent reviews for substance abuse residential facilities. The position serves as a subject matter expert for Health Choice concerning members with substance abuse or co-occurring disorders.
- Conducts prior authorization and concurrent reviews for substance abuse residential treatment facilities and other designated services.
- 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 substance abuse services, and as a resource for program specialties, including cultural appropriateness. Provides support and technical assistance to providers.
- Consults with Medical Director as need to review complex cases.
Education / Experience / Other Requirements
- This position 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
- This position also requires an independent behavioral health license for the state of Arizona.
Years of Experience:
- 2 Years of experience in behavioral health field.
- 2 years of experience with the treatment of members with substance abuse and co-occurring disorders.
- Preferred experience with prior authorization and concurrent review process.
- Knowledge of Arizona Medicaid system and behavioral and AHCCCS health systems
- Psychiatric and substance abuse 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.