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Medical equipment clinician
Location:
Huntington Beach, CA
Description:
Your Role The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Licensed Clinician, Senior, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance. Perform prospective, concurrent and retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as needed prepare and present cases to Medical Director (MD) for medical director oversight and necessity determination Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards and identify potential quality of care issues, service or treatment delays and intervenes or as clinically appropriate Provide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteria Recognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team Support team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards Requires at least 5 years of prior experience in healthcare related field Proficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databases Requires understanding of behavioral health utilization management including application of multiple standardized clinical criteria sets including but not limited to MCG guidelines, nonprofit association guidelines, and various Medicare guidelines For more details: https://jobs-search.org/information-technology_huntington-beach-c426426/medical-equipment-clinician-huntington-beach_i2201656095
Posted:
June 22 on Jobs-Search
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More About this Listing: Medical equipment clinician
Medical equipment clinician is a Technology Medical Equipment Clinician Job located in Huntington Beach CA. Find other listings like Medical equipment clinician by searching Oodle for Technology Medical Equipment Clinician Jobs.
Medical equipment clinician is a Technology Medical Equipment Clinician Job located in Huntington Beach CA. Find other listings like Medical equipment clinician by searching Oodle for Technology Medical Equipment Clinician Jobs.