Clinical Support Specialist - Full-time / Part-time

About the position:

• Located in Wixom, MI
• The Clinical Support Specialist II will assist with clinical department operations supporting a California account
• Schedule is from 11:30am - 8:00pm Mon-Fri

MUST HAVES:

• Bachelor Degree in Social Work
• A minimum of two year's experience in supporting clinical staff in a Community Mental Health setting or 5 years in Behavioral Health clinical service support environment.

Job Description:

• 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 clinical and work site guidelines and renders certification decisions or seeks consultations for non-certification decisions.

About Aerotek:

We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing® Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.

Aerotek is acting as an Employment Agency in relation to this vacancy.