Clinical Support Specialist
3 weeks ago
The Clinical Support Specialist will provide administrative support to the Utilization department at Maple Heights Behavioral Health. This role is responsible for pre-certification and negotiation of continued stay with third-party payers. The specialist will also gather data to support case management activities, including presentation of gathered data and case notes. Additionally, they will coordinate discharge planning with the clinical team, maintain the CRM database with discharge information, and follow up as necessary.
Responsibilities:
- Perform pre-certification and negotiate continued stay with third-party payers.
- Gather data to support case management activities, including presentation of gathered data and case notes.
- Coordinate discharge planning with clinical team, maintain CRM database with discharge information and follow up.
- Present case information and the needs of third-party payers to relevant parties.
- Assist in admissions review, concurrent reviews and discharge planning.
- Assist physician in peer review by serving as information resource, gather data to support review and schedule peer review.
- Informs management about the status of current patients; documents utilization activities as instructed. Participates in performance improvement activities.
Qualifications:
Education/Experience/Skill Requirements:
- High school diploma or equivalent required.
Licenses/Designations/Certifications:
- Current certification as Registered Addiction Specialist, certified Substance Abuse Counselor or similar certification preferred.
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