Intake Clinical Reviewer Job in Randolph 02368, Massachusetts US
Must have 2 years or more working with children and families or with mentally ill
populations, urban youth and crisis management understand Health care and medical
necessity of health care services. This position requires an MSW, Masters in
Counseling, Psychology or Education with a concentration in Counseling or Doctorate
Degree, Speak French Creole OR Spanish (LCSW, LICSW, LMHC, PhD, etc.
preferred).
Job Description:
This position is to enhance the quality of care; and improving patient outcomes.
Conduct initial screening of clients in their community as health care providers to assess for medical necessity. Continue to build upon our success of providing clinically based, objective, and independent monitoring of the quality, appropriateness, and medical necessity of health care services. General administrative clinical duties and support including: Answering calls and attending to all referrals and incoming phone calls regarding authorization reviews, obtain extensions.
Responsibilities:
Conducts prior authorization reviews, obtain extensions to continue services for Community based outpatient mental health services. Enters all review results in appropriate EMR data systems. Assists in the documentation, training and implementation of focused reviews as identified by Joint Health Commission. Researches and understands Medicare service coverage and payment policies, as well as services types enhance internal lower levels of care (In home therapy, Therapeutic mentoring, Community Support programming, Dialectic Behavioral
Therapy, and traditional outpatient behavioral services). Documents all review findings in designated review database. Creates correspondence and communication required by the contract, including denial letters to providers and consumers. Assists the Project Leader, as needed, in fulfilling the contract performance
measures and expectations. Provides positive customer service to both internal and external individuals
and/or organizations. Strives to be helpful, courteous, knowledgeable, and a problem solver. Demonstrates efforts to take the extra steps needed to build strong relationships and organizational promotion. Seeks to constantly and consistently meet or exceed customer expectations. Conducts follow-up activities, as needed
and assigned, and apply the information for organizational impact. Provider Coordination of care for all initial patients and screening for services via phone, as well as over see referring client lower level of care for discharge. Provides clinical screening services to patients, families and hub providers that address personal and environmental issues in order to maximize emotional, social, and physical well being and the appropriate and efficient use of health care resources. Screens and triages patients who request service, are referred, or meet
screening criteria for identifying patients' needs. Conducts psychosocial assessments and provides services as indicated. Partners with the multidisciplinary team to facilitate continuity of care planning. Conduct intakes face to face within the community from time to time, with interns and/or Para professional staff. Provide supervision for initial Dx interview for interns. Presents and/or discusses clinical work in formal and informal settings.