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Managed Care Clinical Specialist

Traverse City, MI

Posted on August 31, 2017

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About Managed Care Clinical Specialist

LOCATION:

Both of these positions are located in MARQUETTE, MI.

POSITION TITLE: 

Managed Care Clinical Specialist, Marquette County

  • Northcare Network is seeking to hire two Managed Care Clinical Specialists

STATUS/HOURS: 

  • Hourly / Non- Exempt; Regular full- time/80 hours biweekly
  • Competitive Wage, plus full-time benefits
  • NorthCare Network, located in Marquette, Michigan, the Prepaid Inpatient Health Plan, serving the residents of Michigan’s Upper Peninsula is currently recruiting an individual to serve as Managed Care Clinical Specialist.

QUALIFICATIONS: 

  • A Master’s Degree in Social Work along with licensure from the State of Michigan as a Licensed Masters Social Worker is required.
  • Consideration may be given to an applicant who holds a State of Michigan licensure as a Limited Licensed Masters Social Worker.
  • One year of professional human services experience involving clinical and case management skills and/or coordination with other health and human services agencies is also required.
  • Additional MCBAP certification is preferred, as is clinical service experience with persons with serious medical illness, persons with substance use disorders, experience with children and adolescence with serious emotional disturbances and adults and children with intellectual/developmental disability.
  • Applicants must also understand and embrace managed care techniques and guidelines, have strong verbal and written communication skills, and the capacity for dealing sensitively with recipients of varying social, economic, educational, racial and ethnic backgrounds, along with personnel from all agencies, and the general public.
  • Literacy in relevant software applications including word processing and spreadsheets is a required; along with understanding of agency philosophical and policy foundation that enables the making of reasonable decisions.
  • Lastly, the ability to maintain recipient and agency confidentiality, and knowledgeable of addiction, treatment, and recovery processes is essential.

RESPONSIBILITIES: 

  • Under the supervision of the NorthCare Chief Executive Officer, this position serves as the clinical entry to services, serves as a community resource for people who are seeking services, coordinates hospital authorizations and utilization review, and makes eligibility determinations both on the phone and at the hospital.
  • This position will serve all NorthCare populations, i.e., people with serious mental illness, serious emotional disturbance, intellectual/developmental disability, substance use disorder, or co-occurring disorders.
  • The Managed Care Clinical Specialist will provide clinical screening and referral services to recipients in the NorthCare Network region.
  • This position works closely with the NorthCare Medical Director, CMHSP program supervisors, NorthCare Access and Eligibility Team, and access and eligibility staff in the region.
  • This person will become an expert in benefit/insurance plans, Medicaid regulations, and medical necessity criteria and be a clinical resource to the UP community about these topics.

Job at a Glance

About NorthCare Network

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