Clinical support specialist ii

Company Name:
ValueOptions is a health improvement company that serves more than 32 million individuals. On behalf of employers, health plans and government agencies, we manage innovative programs and solutions that directly address the challenges our health care system faces today. A national leader in the fields of mental and emotional wellbeing, recovery and resilience, employee assistance, and wellness, ValueOptions helps people make the difficult life changes needed to be healthier and more productive. With offices nationwide and a network of more than 130,000 provider locations, ValueOptions helps people take important steps in the right direction. We help them live their lives to the fullest potential.
At ValueOptions, it's more than a job. Our employees embrace the company vision of helping people lead healthier lives. The over 3,100 employees on our team enjoy challenging career growth in an environment that values integrity, innovation, consumer engagement and joint accountability. Employees have access to comprehensive benefit packages; corporate discounts; continuing education opportunities, including our online learning portal, and more. At ValueOptions we strive to build a boundless culture and community of professionals that includes honest, open and free-flowing communication. We are passionate about the work we do.
If you have a passion to make a difference and a thirst to actively develop your knowledge and skills, join the ValueOptions team!
We are currently seeking a dynamic Clinical Support Specialist II to join our team at our office in Wixom, MI for work schedule of 11:30am-8:00pm. The Clinical Support Specialist II will assist with clinical department operations.
_Position Responsibilities:_
Conduct referrals, follow-up protocols, investigation of complex member/provider issues not requiring a medical necessity determination, claims issues and managing data to ensure patient and provider continuity of services.
Provide guidance and handle complicated inquiries related to case initiation to internal and external customers. Investigate and resolve complaints regarding claims issues or case initiation.
Educate providers/subscribers in the certification process and help reconcile inconsistencies and procedural difficulties. Provide support to Clinical Care Managers and Member Services and Clinical Management.
Initiate cases by taking data over the phone from subscribers, providers and contracted companies. Help to resolve issues and complaints from providers/subscribers needing care management services related to: referrals for treatment, authorizations for services and verification of eligibility information.
Oversee the administration and tracking of appeals, grievances, out of panel authorizations, single case agreements, discharges, aftercare follow-up and administrative waivers. Evaluates clinical appropriateness of treatment using professional knowledge within ValueOptions clinical and work site guidelines and renders certification decisions or seeks consultations for non-certification decisions.
Special projects and other duties including completion of surveys for depression management and mind body health solutions, with transfer to a license clinician for medical necessity determination and emergency assessment based on survey scoring.
All duties as assigned related to providing clinical support.
_Position Requirements:_
Education _: _ Requires _Bachelor's__ degree_in Behavioral Health field (Social Work, Psychology, Counseling, Sociology or Nursing.
Licensure : N/A
Relevant Work Experience: A minimum of two years' experience in supporting clinical staff in a Community Mental Health setting or 5 years in Behavioral Health clinical service support environment.
Knowledge, Skills & Abilities:
Must have experience using management information systems, word processing, and spreadsheet applications including knowledge of Microsoft office.
Excellent time management, organizational skills and telephone service skills required.
Must demonstrate ability to maintain a professional demeanor during crisis situations.
Must possess an excellent work ethic, team attitude and be able to function in a multi-disciplinary team environment.
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ValueOptions is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.
Position Location: MI - Wixom
FTE Status: Full time
Scheduled Weekly Work Hrs: 38
Job Family: Clinical, Unlicensed
ID: 32465

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