Bedford, United States
about 1 year ago
Delivers specific delegated Utilization Management tasks assigned by a supervisor. Assigns client to appropriate staff member or behavioral health network provider for assessment and counseling. Serves as initial contact for clients and their eligible dependents requesting services. Responsible for customer service and relevant standards such as telephone response time. May make referrals within stated limits. Supports and assists with training for employees. May provide guidance around procedures and workflows. Completes day-to-day Intake Care tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members.
Responsible for authorizing Long Term Support Services utilizing Texas Medicaid Healthcare Partnership Medicaid guidelines, STAR+PLUS Handbook, along with company policies and procedures to review/determine services. Ability to communicate effectively with providers, internal and external departments including Services Coordinators and management in an oral and written manner. Answer inquires involving authorizations and/or member eligibility. Work independently with minimal supervision.