Who We Are
Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.
Job Summary
Under the direction of the Supervisor – Behavioral Health is responsible for the daily management of non-clinical reviews supporting the clinical, business and program related work of the department. The Program Coordinator – Behavioral Health functions as a key member of the Program Coordinator Team and the BH Utilization Management department and is a representative of Point32 Health values to both the internal and external customer through written and verbal communication.Key Responsibilities/Duties – what you will be doing
Conducts pre-clinical review validation
o Reviews incoming referrals and obtains necessary demographic data.
o Verifies member eligibility.
o Identifies special coverage or quality events and routes appropriately.
· Manages the review workflows of the department
o Creates the events in the clinical system (MHK, CaseTrakker, Jiva/Ecare) as required and manages the review if indicated.
· Performs basic coverage review for a defined subset of requests
o Review inpatient, outpatient therapy, ABA (Applied Behavior Analysis), CBHI/BHCA (Behavioral Health Services for Children and Adolescents), psych/neuropsych testing, rTMS (Repetitive Transcranial Magnetic Stimulation) and any other level of cares, updating, requesting more information or voiding requests as applicable.
· Participates in departmental operational and administrative processes such as requests for departmental information and follow up as requested.
· Participates in projects and special assignments for purposes of meeting timeliness and department compliance.
· May be required to represent the department on committees.
· Other administrative duties and projects as assigned.
Qualifications – what you need to perform the job
EDUCATION, CERTIFICATION AND LICENSURE:
· Bachelor’s Degree or equivalent relevant work experience is required.
EXPERIENCE:
· Two plus years of experience in a business environment required managed care/health industry environment experience preferred.
SKILL REQUIREMENTS:
· Advanced verbal and written communication skills
· Demonstrate proficiency and accuracy in performing data entry tasks in multiple applications
· Appropriately identify urgent situations and follow the established protocol
· Has the ability to manage multiple priorities as well as possesses the initiative and judgment to operate within a politically sensitive framework.
· Exhibits initiative and is self-directed and self-motivated in work performance.
· Strong organizational, problem solving, and conflict resolution skills and the attention to detail necessary to act within a complex environment
· Excellent interpersonal skills. (Position requires daily contact, by telephone, with network providers and their office staff, hospital contacts and Tufts Health Plan internal departments.)
Compensation & Total Rewards Overview
As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.
Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:
Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health
For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/
Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity
Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org