Clinical Support Specialist II (Social Work)
Posted on: May 7, 2021
**Our client is looking to add a Clinical Support Specialist II
to their team. From April 2021 - Dec 2021 it is going to be a work
from home opportunity. The company as a return to work plan that
will have employees working in the office again as of Jan 2022.
This position is the front line interface to members and providers
who seek information about behavioral health benefits. Assist
callers by providing benefit and eligibility information and
referrals to network providers.**
Assist with Clinical Department operations 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.
Educate providers/subscribers in the certification process and help
to reconcile inconsistencies and procedural difficulties.
Duties and Responsibilities
1. Interface with medical carriers, claims payers, other. Initiates
and maintains positive and productive relationships with external
and internal customers. Handles difficult customer service problems
and expedites resolution.
2. Assist department/unit with call management. Interface with
external and internal customers to ensure optimal efficiency of
accessing behavioral health services. Provide education to
providers and members on all aspects of care management services.
Perform review of service request for completeness of
Verifies member benefits and eligibility through health plan
computer access, phone, and e-mail. Educates callers about services
available to them and their mental health benefits. Obtains urgent,
routine with assistance appointments within established time frame
guidelines. Checks voice mail and return calls within 1 business
Checks e-mail to stay informed of procedures and communicate with
Works with health plan, County entities, community agencies and
providers to effectively coordinates member care.
3. Verify benefits against contract requirements prior to case
initiation. Refer complicated inquires to Care Managers. Complete
transactions/authorizations. Prepare account specific cases for
Care Manager follow-up. Process account specific outpatient
authorizations. Assist with triage assessment and referral
4. Perform follow-up services for cases that may include CDR/EAP
involvement & associated tasks, ambulatory follow-up procedures,
depression management, medical/behavioral coordination and
intensive care management protocols. Screen psychological testing
requests for Care Manager follow up. Assist with specialty/distance
waivers by completing rate negotiations and appropriate paperwork.
Assist Care Managers in gathering data and making appropriate
referrals to providers.
5. Search for specialty providers or referrals in areas with
difficult access and may respond to complicated inquiries. May
participate in the investigation and resolution of claims and/or
case issues. Oversee and support work process for clerical support
staff. Collect and transfer non-clinical data. Acquire structured
clinical data. Perform activities that do not require evaluation or
interpretation of clinical data. Obtain and enter discharge
information. Participate in periodic systems testing.
6. Administer, track and record complaints, appeals, out of network
authorizations including research and referrals in difficult access
areas. Process appeal/denial issues. Investigate and resolve
customer issues/complaints. Prepare and send out appeal letters per
7. Perform responsibilities in accordance with contract standards.
Provide training, as needed based on department needs. Assist
service center with compliance of regulatory standards.
8. Initiate and maintain all databases and records used by the
Department. Enter data, update and/or correct information, run
queries and reports. Prepare symposium reports.
Social work, Behavioral health, Clinical assessment
+ Bachelor's in Social Work (preferred) / will also consider a
Bachelor's in Psychology
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
The company is an equal opportunity employer and will consider all
applications without regards to race, sex, age, color, religion,
national origin, veteran status, disability, sexual orientation,
gender identity, genetic information or any characteristic
protected by law.
Keywords: Aerotek, Detroit , Clinical Support Specialist II (Social Work), Healthcare , Wixom, Michigan
Didn't find what you're looking for? Search again!