Candidate can be located in any time zone as long as they can commit to the CST hours for the role i.e., 10:30 AM - 7:00 PM CST.
Top 3 skills needed in candidates are empathy, strong technology skills and multi tasking.
Candidates MUST have reliable internet connection
Duties
Complete scheduling of peer reviews for all lines of business (CAMS, TruCare, and CareAllies) which includes building and verifying template information, making outbound/receiving inbound calls from facilities and providers to schedule reviews, coordinating MD/PHD calendars, documenting in the case, assigning for follow-up, and notifying Care Managers
Provide verbal determination to facilities and providers on results of peer reviews
Complete follow-up on cases after peer review including: creating alternative level of care authorizations, discharge planning, and appeal requests
Utilize workflows efficiently to ensure accurate documentation and adhere to compliance guidelines
Responsible for management of MD Scheduling mailbox
Work closely with internal matrix partners to ensure legal, federal, and state mandates are in compliance, and NCQA and URAC accreditation guidelines are met
Proficiently communicate with matrix partners including appeals coordinators, case managers, medical directors, individual HCP’s, and facilities
Provide exceptional customer service, collaborating closely with matrix partners, to ensure each case is completed and effectively communicated to the customer and facility in a timely manner
Additional tasks as assigned
Skills
At least 2 years of experience in behavioral health services setting
Strong verbal, written, and interpersonal communication skills
Effective listening and analytical skills
Extremely detail-oriented and proficient in organizational skills
Strong ability to switch-task and exhibit excellent prioritization skills
Experience working on multiple projects simultaneously under tight deadlines
Technical knowledge of automated databases, tracking systems, and spreadsheet applications
Ability to manage change effectively and assist in leading others through the change process
Education
Bachelor’s degree in mental health field or psychology/social work related field required (can also include: family communications, health coaching, community/public health or other related major).
This is a non-clinical role and does not require a license
Previous customer service experience or related position
CPRA: Notice to California Applicants: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.
Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.
California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer.
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $20.00/hr.
