Supervisor, Behavioral Health


Alliant Health Solutions
3452 LAKE LYNDA DR Ste 345
ORLANDO, FL 32817-1430
United States

Category
Industry
Healthcare / Health Services
Manages Others
Yes
Experience Required
Yes
Degree Required
No
Security Clearance Required
Yes Must pass background check
Employment Type
Employee/Contractor
Work Schedule
Full-Time
Travel
Unspecified

Job Description

 

POSITION SUMMARY

The Supervisor, Behavioral Health functions in a dual role by providing clinical supervision for assigned behavioral health review teams and also performing behavioral health reviews. The primary responsibilities of the Supervisor, Behavioral Health are listed below:

ESSENTIAL SUPERVISORY JOB FUNCTIONS

  • Responsible for supervision, oversight and approval of duties for assigned behavioral health review teams, including, but not limited to the following:
  • Creates and monitors team assignments to ensure accuracy and timeliness of behavioral health reviews in accordance with productivity goals and deliverables.
  • Facilitates customer calls and responds to customer needs.
  • Identifies and documents cases for escalated evaluation by Manager or Director of Operations.
  • Communicates weekly status updates and deliverable reporting to Program Manager.
  • Works in close collaboration with clinical team members to support the development of new projects and the continuous improvement of operational processes.
  • Conducts orientation and training of new hires to their respective job responsibilities; and educate staff on process changes.
  • Provides regular coaching feedback; Evaluates team members during orientation period and annually, as required.
  • Reviews paid time off (PTO) requests of assigned team members and makes sure there is adequate operational coverage.

ESSENTIAL CLINICAL REVIEWER JOB FUNCTIONS

  • Performs desk reviews through claims analysis and develops the appropriate approach for the review.
  • Performs reviews accurately and efficiently within time requirements as specified and performs accurate data entry of required review-specific information.
  • Evaluates submitted information and reviews claims that meet policy or medical necessity. Utilizes experience and clinical judgment, when appropriate, to approve/deny claims.
  • Renders appropriate decisions based on the information received using the established policies/medical necessity guidelines; and clearly and concisely documents the rationale for all decisions rendered.
  • Identifies and documents cases for escalated evaluation by Manager or Director of Operations.
  • Makes recommendations based on clinical judgment and experience for the necessity of the services and the appropriateness of the setting while substantiating recommendations with clinical rationale.
  • Analyzes, interprets and documents appropriate determination of estimated recoverable amounts from specified Medicaid providers through review and identification of policy compliance and coding/billing patterns.
  • Completes required reports and presents findings to customer during scheduled meetings.

KNOWLEDGE, SKILLS AND ABILITIES

  • Strong background and proven knowledge with behavioral health, including clinical writing/documentation and verbal presentation skills.
  • Strong theoretical clinical knowledge base and problem-solving skills.
  • Strong organizational skills with ability to demonstrate work priorities and attention to detail while maintaining focus on deliverables and time management.
  • Demonstrates ability to perform work with considerable independence by use of creative thinking, thorough analysis of problems, initiative and use of innovative approaches to problem resolution.
  • Intermediate knowledge of Microsoft Office, including Word, Excel, and Outlook including data entry skills.
  • Excellent interpersonal, written and verbal communication skills required.
  • Valid Driver’s License required with the ability to travel as needed

EDUCATION, EXPERIENCE, AND TRAINING

  • Licensed Mental Health Professional (LMHP) or Psychiatric Registered Nurse (RN), with bachelor’s degree preferred.
  • Three (3) to Five (5) years behavioral health experience required, with preferred experience with behavioral health auditing and coding, managed care, and/or utilization management.
  • Prior charge role, team lead, or supervisory experience are preferred.
  • Ideal candidate is based in the Central Florida (Orlando) area preferred.
Employer
Alliant Health Solutions
Tammy Johnson
1455 Lincoln Parkway Ste. 800
Atlanta GA 30346
United States