Extended Care Manager in Jacksonville, Florida

For details and to apply, please visit
/j/6768172
Job Title: Extended Care Manager
Company Name: CSI Health
Location: Jacksonville, Florida
Job Type: Full-Time
Profession: Manager
Career Level: Experienced
Experience: 3-5 years
Education Level: Masters Degree
Job Details:
The CSI Companies is actively searching for an Extended Care Manager located in Jacksonville, FL.
Job Description:
Provide utilization management for TRICARE South eligible beneficiaries for Applied Behavioral Analysis (ABA) services.
Reviews care in accordance to TRICARE Manual for services covered under Extended Care Health Option (ECHO), Autism Spectrum Demonstration (Demo), ABA Pilot for Non-Active Duty Family Members (NADFM) and Basic ABA benefit for TRICARE South Region Contract eligible beneficiaries.
Conduct benefit and medical necessity first level review using professional knowledge, TRICARE standards, Clinical Criteria, most current DSM, URAC standards, recognized therapeutic modalities, treatment planning and discharge planning review for pre-authorization as well as concurrent care.
Perform all duties within the scope of his/her licensure.
Perform assessment of clinical data received via telephonic, electronic and written transmission to determine TRICARE ABA benefits, TRICARE manuals adherence, acuity of needs, appropriate services requested, and complete an authorization determination.
Provide beneficiaries and external customers with accurate information regarding benefits and utilization management practices, in accordance to Policies and Procedures and Standard Operational Procedure (SOP).
Reviews the ABA initial behavioral plan, psychometric testing standards, and progress report(s) submitted by treating provider(s). Determines if all TRICARE standardize components are indicated such as support targeted skills, goals and objectives that are measurable, time limited and appropriate for beneficiaries.
Reviews ECHO referrals received through all reports, directly referred by fax, telephonic, or web based pend system. Verifies that beneficiary meets ECHO criteria. Attempts to contact eligible beneficiaries/families to offer ECHO services in compliance with TRICARE, VO and URAC standards and timeframe. Open referral or factually deny as appropriate.
Demonstrates a working knowledge of the benefits of the Extended Care Health Option (ECHO) and Autism Spectrum Demonstration (ASD) and application requirements. For beneficiary’s approved for ECHO benefits, authorize appropriate provider(s) for services under ECHO (such as respite care and Durable Equipment) and for ASD ABA Reinforcement in accordance with Standard Operational Procedures (SOP).
Demonstrates a working knowledge of the benefits of the ABA Pilot for Non-Active Duty Family Members (NADFM). For eligible beneficiaries, will authorize appropriate providers(s) for Pilot ABA reinforcement services in accordance with Standard Operational Procedure (SOP).
Demonstrates a working knowledge of the ABA basic benefits. For eligible beneficiaries, will authorize appropriate providers(s) for ABA basic services in accordance with Standard Operational Procedure (SOP).
Completes calls and documents appropriate actions in Active Advice for ECHO enrolled beneficiaries. Ensures all accepted cases are contacted at minimal intervals in accordance with TRICARE Standard Operating Procedures (SOP) for the type of case.
Accurately and professionally document all authorization decisions, communication with providers, beneficiaries, verification of eligibility, and provider status into the MSR system, Active Advice, INFOrm and/or Access DataLog complying with contractually established timeframe standards.
Acts as a resource and provides oversight, guidance and assistance to functions assigned to ECHO Customer Assistant (ECA) staff. Provides feedback to ECHO Supervisor regarding ECA performance.
Refer to Case Management as appropriate.
Researches, identifies, links and educates beneficiaries, their families, and providers with appropriate MTF, federal, state and local community resources.
Communicates with Managed Care Support Contractor (MCSC) to ensure a seamless cross regional transfer, when applicable.
Attend and actively participate Service Center meetings, clinical rounds, regularly scheduled staff meetings and mandatory educational and training presentations. Keep self-abreast of current policy and procedures by utilizing the available resources within the department to include the intranet, e-mails, team meetings, clinical rounds, etc…
Identifies and provides information and updates to the ECHO Supervisor, Director of Clinical Services, Medical Director and Quality Management Department on high-risk cases.
Provide assistance with calls that have been identified by non-clinical staff to be of a potential crisis situation (i.e. threaten of harm to self or others). Will assess the seriousness of the situation and appropriately triage the care to the most appropriate level. Will document the interaction in the most secure source possible.
Maintain and demonstrates a professional relationship in all interactions with internal and external customers. Contributes to a productive work environment.
Monitor the delivery of care from clinical information obtained for any potential patient safety, potential fraud, or quality issue and notifies the appropriate UM supervisory staff and/or the Clinical Quality Department through the established PQI process.
Acquire and appropriately apply knowledge of TRICARE Manuals, Clinical Criteria, most current DSM, URAC standards, recognized therapeutic modalities, treatment planning, pharmacology, and discharge planning when performing first level medical necessity review.
Will utilize our clients Policies and Procedures (P &P) and Utilization Management Department Standard Operational Procedures (SOP) as direction and guidance to perform UM/CM work functions.
Completes VO Federal, VO National, Humana Military, TRICARE and URAC training requirements by indicated deadline.
Complies with established HIPAA guidelines and reports any possible violations immediately to his/her immediate supervisor and/or the designated HIPAA officer.
Ability to be flexible and adjust to continuous changing circumstances.
Participates in the orientation and mentoring of new hire personnel to our client.
Reads and responds to all business email communications in a timely manner.
Adhere to objectives as outlined in the Introductory or Annual Performance Appraisal.
Assist with special projects and other duties as assigned by management.
Job Requirements:
Job Requirements:
Master’s Degree (in Social Work, or Marriage and Family Therapy, or Mental Health Counseling) Doctor of Philosophy (PHD), Doctor of Psychology (PsyD), or Associate’s Degree in Nursing required.
Bachelors of Science Degree in Nursing preferred.
Current, Active, Unrestricted, Valid Florida License in Social Work, Marriage and Family Therapy, Psychology, Registered Nursing or as Licensed Mental Health Counselor (LMHC). LMHCs must meet TRICARE Policy Chapter 11, Section 11 as a TRICARE Certified Mental Health Counselor.
Minimum of three years clinical experience. Prefer psychiatric mental health/substance abuse field experience.
Interpersonal skills, which allows for professional and positive relationships with co-workers, consumers, families, and other community members.
About CSI Health:
CSI Health is one of the fastest growing Healthcare recruiting and consulting firms in the United States specializing in clinical and non-clinical hiring needs. Our team, of dedicated healthcare recruiters, brings more than 50+ combined years of experience to our candidates and clients.
We specialize in placing healthcare professionals into direct hire and contract assignments. We pride ourselves on the opportunities that we are able to present to our candidates, competitive urgency, and personal touch. Our dedicated and experienced team is available any time to assist you with your career choice. You will have a dedicated recruiter whose only concern is advancing your career. Working with us allows you the ability to seek out dream jobs- flexible hours, challenging environments and top pay!
For details and to apply, please visit
/j/6768172
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