Experienced Care Representative Customer Service – careerzynith Remote Opportunity

At careerzynith, we're dedicated to revolutionizing the way healthcare services are delivered, and we're looking for a talented Care Representative Customer Service to join our dynamic team. As a fully remote role, this position offers the flexibility to work from anywhere, allowing you to strike a perfect balance between your personal and professional life.

• *Job Overview**

Join our esteemed healthcare organization as a Care Representative Customer Service, where you'll have the opportunity to make a significant impact on the lives of our members. In this vital role, you'll be responsible for providing exceptional customer service, navigating complex healthcare systems, and ensuring that our members receive the highest quality of care based on medical necessity.

• *Key Responsibilities**

As a Care Representative Customer Service, you'll be responsible for:

• Navigating a mission-focused environment dedicated to excellence in member service and care management, demonstrating integrity and accountability.
• Collaborating effectively with team members to fulfill departmental objectives and support both immediate and long-term goals.
• Assessing requests for medical appropriateness and verifying referrals according to established clinical guidelines.
• Collecting pertinent medical information for review by the Medical Director and communicating decisions clearly.
• Accurately documenting all necessary information in the utilization management system, ensuring updates on authorizations are recorded.
• Conducting thorough reviews of submitted documentation for compliance with coding (ICD-10, CPT-4, HCPCS) and coverage guidelines.
• Maintaining adherence to established policies and procedures while conducting quality reviews of documents.
• Promptly notifying providers and members of decisions made, ensuring timely and effective communication.
• Staying updated on federal, state, and local regulations pertaining to the BHT benefit.
• Identifying potential quality concerns and reporting them as necessary, assisting with case audits when required.
• Participating in additional projects and responsibilities as assigned.

• *Required Skills**

To succeed in this role, you'll need to possess:

• Strong relationships with colleagues and external partners from diverse backgrounds.
• The ability to work autonomously while exercising sound judgment in decision-making.
• Effective communication skills in both verbal and written formats.
• Adaptability to a flexible work schedule that may include evenings and weekends.
• Strong organizational, analytical, problem-solving, and project management skills.
• The ability to prosper in a fast-paced work environment while managing multiple tasks simultaneously.
• The ability to inspire and motivate team members and external committees.
• Proficiency in Microsoft Office Suite (Word, Outlook, Excel, PowerPoint) and related applications.

• *Qualifications**

To be considered for this role, you'll need to possess:

• A Master's degree in psychology, social work, counseling, or a related field, along with a minimum of four years of experience in providing ABA or mental health services, including clinical review and treatment plan oversight.
• Current, unrestricted California license (LCSW, LPCC, LMFT, RN with BH experience, BCBA, or BCBA-D).

• *Career Growth Opportunities**

At careerzynith, we value your professional development and offer numerous opportunities for skill enhancement and career advancement within the healthcare sector. Our organization is committed to helping you grow and succeed in your career, with a focus on providing you with the tools and resources you need to excel.

• *Company Culture And Values**

We foster a collaborative environment that emphasizes high-quality performance and member service, nurturing a culture of dignity and respect. Our organization is dedicated to providing a supportive and inclusive work environment that allows our employees to thrive and reach their full potential.

• *Networking And Professional Opportunities**

In this role, you'll have the chance to collaborate with a dedicated team, enhancing your professional network and skillset in the healthcare community. Our organization is committed to providing opportunities for professional growth and development, with a focus on helping you build meaningful relationships with your colleagues and external partners.

• *Compensation And Benefits**

We offer a competitive salary commensurate with experience, as well as comprehensive benefits, including:

• Comprehensive health, dental, and vision insurance.
• Retirement savings plan with company matching contributions.
• Generous vacation and paid time off policies.

• *Employment Type**

This is a full-time position, offering a stable and secure work environment with opportunities for growth and advancement.

• *Ready for an Easy Start?**

This is a low-stress role with great rewards. If you're reliable and willing to learn, we want you. Apply now and take the first step towards a fulfilling career with careerzynith.

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