Team Coordinator, Medical Social Work

Location
Norfolk, VA
Salary
Competitive
Posted
Aug 08, 2019
Closes
Aug 16, 2019
Ref
127411BR
Function
Management
Industry
Healthcare
Hours
Full Time
Assumes responsibility, accountability and leadership for the daily operations including coordination of work, quality, and service. First line supervisor in the Utilization Management Department. Facilitates the work of assigned team members. Provides a leadership role in ongoing utilization review competency assessment, needs identification and educational offerings. Provides educational services to the Utilization Management staff. Participates in the work activities of assigned teams. Responsible for review of clinical information received from providers ensuring clinical data is substantial enough to meet Medical Necessity Criteria to authorize services as needed. Requires knowledge of managed care contracting, Medical Necessity, CMHRS services, DMAS protocols, clinical protocols and clinical review requirements. Requires knowledge of contractual, regulatory and compliance requirements for government payers, self funded and commercial payers. Ensures appropriate and accurate information is entered into claims system for processing of payment.

Qualifications

Education Level
Master's Level Degree OR
RN-Bachelor's Level Degree

Experience
Required: Clinical - 3 years, Related - 3 years

Preferred: Supervisory - Previous experience

License
Required: License Clinical Social Worker, Registered Nurse

Preferred: None, unless noted in the "Other" section below

Skills
Required:

Preferred: None, unless noted in the "Other" section below

Other
BSN or Master's in Social Work required. 3 years experience working in either in patient or outpatient services dealing with authorizations and medical necessity criteria and 3 year experience working with vulnerable populations. Virginia RN license or LCSW required.

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