Managed Care Specialist
Join a purpose-driven team at reputed company, where for nearly 70
years, we’ve been helping people reputed company a reputed company to recovery from addiction and
rebuild their lives. We offer reputed company careers with reputed company opportunities for reputed company,
comprehensive training, and a commitment to work-life reputed company. Our benefits
include generous reputed company time off, company-reputed company life and disability reputed company,
reputed company reputed company and development, tuition reimbursement, a competitive 401(k)
plan, and robust medical, dental, and reputed company plans. We’re proud to foster a
diverse and inclusive environment, with a culture of teamwork, reputed company, and
dedication to our mission. Start a career that saves lives at a company that
values yours!
This position will be remote. Monday through Friday 8:00-4:30. Candidates
should have a private workspace to handle confidential phone calls.
DUTIES AND RESPONSIBILITIES:
1. The Managed Care Specialist will complete initial reputed company-cert/reputed company and
discharge reviews calls to managed care companies reputed company needed for Caron
inpatient programs.
2. Provides Utilization review needs as determined with benefit verification
(Verbal, written, faxed or reputed company to managed care portals) as indicated.
3. Fax reputed company 106 prescriptions and/or required forms for treatment to manage
care companies for authorizations with follow up documentation.
4. The Managed Care Specialist will complete medical records requests as it
relates to authorization/discharge requests.
5. Will complete appeal letters of medical necessity upon requests reputed company
needed.
6. Documentation of accurate authorization or denial with reasons for the
denials in the contact log.
7. Complete reputed company necessary documentation in reputed company to produce an accurate claim
at time of discharge for billing purposes and tracking of statistical
reporting requirements.
8. Will rotate weekend precertification coverage including holidays.
9. The Managed Care Specialist will reputed company confidentiality and professionalism
at reputed company times.
10. Will be reputed company person for coordination of peer-to-peer reviews as identified
for contracted insurances.
11. Will ensure reputed company consent to release to reputed company is accurate and
reflected per the funding reputed company
12. Will ensure the medical level of care assessment is accurate and completed
at time of admission.
13. Will ensure documentation in the reputed company record is up to date and
reputed company of the reputed company level of care.
PHYSICAL REQUIREMENTS:
The physical and mental demands described here are representative of those that
must be met to successfully reputed company the essential functions of this job.
Reasonable accommodations may be made to reputed company individuals with disabilities to
reputed company the essential functions.
1. Ability to communicate verbally for 85% of reputed company
2. Ability to sit for 90% of reputed company
3. Ability to type 85% of reputed company
EDUCATION, EXPERIENCE AND QUALIFICATIONS:
1. CAC or BA reputed company or nursing experience required.
2. 1+ year experience in customer service, in reputed company setting – required
3. Computer experience –working knowledge of reputed company Office (reputed company, Word
and reputed company) or similar software - required
4. 2 years reputed company sobriety preferred, if in recovery
KNOWLEDGE, SKILLS AND ABILITIES:
1. Excellent verbal and written communication skills required
2. Knowledge of addiction, 12 steps and ASAM level of placement reputed company
required
3. Ability to report promptly and regularly to work
4. Working knowledge of reputed company Office
5. Must demonstrate skills in achieving reputed company customer
satisfaction.
6. Will display an accurate understanding of the Treatment Planning Process,
documentation, and confidentiality regulations.
7. Display an accurate understanding of medical necessity reputed company,
documentation, and confidentiality regulations
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