Therapist, Managed Care - Contract

GENERAL SUMMARY

Under direction, provides linkage and referrals to individuals seeking Macomb County Community Mental Health (MCCMH) services; determines eligibility and medical necessity of services needed; reviews requests for services from a utilization management perspective; maintains clinical and administrative records; coordinates, consults and provides liaison work with other agencies and systems; ensures that service authorizations are timely; implements program goals and activities in keeping with program philosophy; contributes expertise from professional discipline to team planning and treatment processes.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

Completes telephonic screenings for a variety of populations, SMI, SUD, IDD, to determine clinical need for urgent, emergent, or routine services.

Conduct eligibility and medical necessity reviews for prior authorization requests.

Processes electronic and telephonic requests for psychiatric hospitalization and other crisis services.

Conduct brief reviews, document findings, and ensure authorization requests are processed in accordance with regulatory requirements, contractual obligations, and organizational policies.

Completes case documentation following MCCMH policies and procedures.

Apply authorization guidelines, benefit policies, and organizational policies consistently.

Maintains appropriate contact with service providers to coordinate care and referrals.

Explain coverage determinations and authorization processes in a professional and customer-focused manner.

Ensure individuals receive medically necessary service authorizations within benefit and organizational guidelines.

Serves on Community Mental Health or community-based committees.

Performs related duties as assigned.

Classification Title Therapist – Managed Care Operations

Employer America’s Back Office (BAO) / Venture

QUALIFICATIONS

Required Education and Experience

• Master’s degree in social work, Counseling, Psychology or Doctorate in Psychology or a directly related mental health field from an accredited college or university
• Two (2) years of clinical experience working in a mental health setting

Preferred Education and Experience

• Previous experience in utilization management
• Knowledge of Macomb County Provider Network

Required Licenses or Certifications

• Licensed Master Social Worker (LMSW), Limited Licensed Master of Social Work (LLMSW), Licensed Professional Counselor (LPC), Limited License Professional Counselor (LLPC), Temporary Limited Licensed Psychologist (TLLP), Limited License Psychologist (LLP), or Licensed Psychologist (LP)
• Possession of required state licensure appropriate to the position and the ability to meet privileging and credentialing guidelines
• Possession of a valid Michigan driver's license and operable, insured automobile for authorized travel

Preferred Licenses or Certifications

• Certification with the Michigan Certification Board for Addiction Professionals (MCBAP) or an approved development plan

COMPETENCIES FOR SUCCESSFUL PERFORMANCE OF JOB DUTIES

Knowledge of:

• Working knowledge of non-Medicaid funding in the PIHP/CMHSP environment.
• Knowledge of Macomb County Provider Network
• Resources within MCCMH and outside of Macomb County Community Mental Health
• Michigan Mental Health Code and 401 criteria
• Mental illness, serious emotional disturbance, and developmental disabilities
• Techniques to de-escalate/interact in potentially dangerous situations
• Knowledge of applicable computer applications.
• Knowledge of third-party insurance procedures and requirements.
• Knowledge of Medicare insurance procedures and requirements.

Skill in:

• Using good professional judgment and initiative.
• Providing excellent and timely customer service
• Performing a variety of duties, often changing from one task to another

Ability to:

• Collaborative: Approaches all situations with teamwork and a solution-focused mindset, demonstrated through active participation in meetings, volunteering to assist teammates and other departments as appropriate. Examples include participation in internal and external committees, subcommittees, process-improvement groups, and other multi-organizational initiatives.
• Accountable: Takes ownership and empowers others to do the same, as evidenced by identifying solutions and acting on job responsibilities and organizational objectives daily.
• Respectful: Treats people with dignity while honoring individual differences demonstrated through use of positive and encouraging statements and/or interactions to, about, and/or with colleagues and persons served; evidenced by supervisor observation, feedback from other department staff, and leadership.
• Effectively speak, write, and understand English.
• Effectively speaking, writing, and understanding a language other than English is preferred.
• Understand and carry out oral and/or written instructions.
• Accurately organize and maintain paper documents and electronic files.
• Maintain the confidentiality of information.
• Work independently

GENERAL REQUIREMENTS AND DISCLAIMERS

Complies with P.A. 390, as amended, known as the State’s Emergency Management Act and the County’s Emergency Management resolution as well as all related plans, policies and procedures covered by those statutes.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by employees in this job. Employees may be requested to perform job-related tasks other than those specifically presented in this description.

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment amongst other possible accommodations.

GRANT OR EXTERNALLY FUNDED POSITION –This position will continue only if sufficient grant or external funds are provided.

Pay: $34.46 - $44.57 per hour

Expected hours: 37.5 per week

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Vision insurance

Application Question(s):

• Do you have at least two (2) years of experience working in a mental health setting?
• Do you hold any of the following license: Licensed Master Social Worker (LMSW), Limited Licensed Master of Social Work (LLMSW), Licensed Professional Counselor (LPC), Limited License Professional Counselor (LLPC), Temporary Limited Licensed Psychologist (TLLP), Limited License Psychologist (LLP), or Licensed Psychologist (LP)

Education:

• Master's (Preferred)

License/Certification:

• Michigan Driver's License (Required)

Ability to Commute:

• Clinton Township, MI 48038 (Preferred)

Work Location: In person

Salary : $34 - $45