The Behavioral Care Advocate reviews clinical documentation to determine appropriate level of care and authorization as needed. Additionally, for providing clinical case management activities across the continuum of care from assessing to coordinating, monitoring and evaluating. This position provides telephonic education and quality monitoring.
Understands case management philosophy and principles the role of utilization management, its philosophy and principles.
Obtain the necessary knowledge of regulatory standards and Level of Care guidelines established by CMS and community standards.
Provide utilization review services through review of outpatient behavioral health treatments for medical necessity and quality of care.
Conducts authorization, concurrent review, coordination and assurance that members are at an appropriate level of care.
Focus on utilization review of behavioral health and substance abuse services.
Coordinating benefits and transitions between various areas of care.
Identifying ways to add value to treatment plans and consulting with facility staff on those ideas.
Reviewing cases and analyzing clinical information in conjunction with Medical Directors to determine the appropriateness of level of care and ensure documentation meets payer and regulatory requirements.
Escalating cases to the Medical Director for case discussion or peer-to-peer intervention as appropriate.
Master's degree-level clinician in Psychology, Social Work, or Counseling
LSW, LICSW, LMFT or LP licensure
3 years of experience in a related mental health environment.
3-5 years of utilization management experience encompassing work with all member age ranges and multiple payors.
2 years of demonstrated proficiency in computer software and hardware applications and basic knowledge of statistics.
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.
Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.
Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider netwo...rk and health insurer PreferredOne. In partnership with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.