Behavioral Health Absence Specialist

Shape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. Without our employees, we would not be able to innovate health care for our patients and health plan members. From hospitals to our corporate office, all UPMC employees impact our mission of creating life-changing medicine. To continue our tradition of excellence, we are in search for a Behavioral Health Absence Specialist to join this community as well.

This position will focus on behavioral health disability case management activities for WorkPartners Absence Management area. As needed to ensure adequate caseload, this position will also deal with minor medical disability cases. 

Responsibilities:
 

• Advises employees, employee's family members, managers and HR Professionals on leave and disability policies and processes. 
• Coordinates the leave process; verifies eligibility, determines leave and disability approvals, calculates leave length, coordinates the applicable client leaves including integration with state leave laws, monitors maximum duration of leave allowed under federal/state and/or client policy, and supports the return-to-work process
• Applies concepts and rules as mandated by guidelines for FMLA, ERISA and other federally or state mandated or company specific policies. 
• Answers and addresses employees leave related questions, concerns in a timely manner.
• Conducts interview telephonically with employees applying for a disability to collect provider information, treatment plan and employees current level of functioning
• Contacts providers (telephonically, via fax) to collect and or clarify medical information needed to support a disability claim
• Collaborates with health care providers and ill/injured employees to update the status of treatment plan and length of disability.
• Reviews medical information submitted on behalf of the employee, job description and summary plan description to make a disability claim determination
• Monitors employee's care and progress during a disability by reviewing medical documentation from employee and/or employee's treating provider to document the employee's continued absence and maintain updated medical records
• Assists disability specialists on complex cases with behavioral health comorbidities and assists with making claims decisions.
• Uses system workflow to manage case activities in a timely manner
• Completes all case activities in case notes
• Interacts with business partners telephonically, via email and instant messaging
• Works with Clinical Case Mangers and Physician Consultants to review complex/questionable claims
• Participates in a multidisciplinary team to Identify and refer to UPMC clinical resources community resources to address factors that impact return to work
• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and employee.
• Responsible for resolving issues by interacting with employee's manager, Human Resources, payroll, or disability specialists.