Managed Care Specialist

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🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

⏰ Full Time

🟢 Junior

👻 Ghost score 15%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Caron Treatment Centers

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1957

🏥 Healthcare

💼 Consulting

🤝 Non-profit

Healthcare • Consulting • Non-profit

Caron Treatment Centers is a nonprofit provider of addiction and behavioral-health treatment that combines evidence-based and neurorestorative care to deliver inpatient and outpatient programs, detox, family services, and ongoing recovery support. With campuses in Pennsylvania and Florida, multiple outpatient centers (including Atlanta and Philadelphia), virtual services, and specialized tracks for populations such as young adults, healthcare professionals, LGBTAIQ+ individuals, and aviation professionals, Caron focuses on long-term, sustainable recovery, accepts in-network insurance, conducts research and training, and sustains programs through donations and community support.

📋 Description

• Complete initial pre-certification, concurrent, and discharge review calls to managed care companies for Caron inpatient programs • Provide utilization review based on benefit verification through verbal, written, faxed, or managed care portal access • Fax ACT 106 prescriptions and required treatment forms to managed care companies for authorizations and follow-up documentation • Complete medical record requests related to authorization and discharge requests • Complete appeal letters of medical necessity when requested • Document accurate authorizations or denials and reasons for denials in the contact log • Complete documentation in Aura to support accurate discharge claims, billing, and statistical reporting • Rotate weekend precertification coverage, including holidays • Maintain confidentiality and professionalism • Coordinate peer-to-peer reviews for contracted insurers • Ensure proper consent to release information to insurance is accurate and reflects the funding source • Ensure medical level-of-care assessments are accurate and completed at admission • Keep clinical-record documentation current and reflective of the current level of care

🎯 Requirements

• CAC or BA in Human Services or nursing experience required • 1+ year experience in customer service, in a healthcare setting required • Computer experience and working knowledge of Microsoft Office (Outlook, Word and Excel) or similar software required • Excellent verbal and written communication skills required • Knowledge of addiction, 12 steps and ASAM level of placement criteria required • Ability to report promptly and regularly to work • Ability to achieve internal and external customer satisfaction • Understanding of the Treatment Planning Process, documentation, and confidentiality regulations • Understanding of medical necessity criteria, documentation, and confidentiality regulations • Private workspace to handle confidential phone calls • Ability to communicate verbally for 85% of the workday • Ability to sit for 90% of the workday • Ability to type for 85% of the workday • 2 years continuous sobriety preferred, if in recovery • Willingness and ability to rotate weekend precertification coverage including holidays

🏖️ Benefits

• Generous paid time off • Company-paid life and disability insurance • Professional growth and development • Tuition reimbursement • Competitive 401(k) plan • Medical, dental, and vision plans • Diverse and inclusive environment • Teamwork, compassion, and dedication to the mission • Comprehensive training • Work-life balance