101 Counseling Services jobs in Marion County

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members

ESSENTIAL RESPONSIBILITIES

• Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.

• Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.

• Participate in protocol and guidelines development to ensure consistency in the review process.

• Actively manage projects and/or participate on project teams that require a physician subject matter expert.

• Other duties as assigned.

EDUCATION

Required

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)

Substitutions

• None

Preferred

• Master's Degree in Business Administration/Management or Public Health

EXPERIENCE

Required

• 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)

Preferred

• 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry

LICENSES AND CERTIFICATION

Required

• Medical Doctor or Doctor of Osteopathic Medicine (DO)

• Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards

• Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.

Preferred

• None

SKILLS

• Critical Thinking

• Case Management

• Customer Service

• Oral & Written Communication Skills

• Collaboration

• Listening

• Telephone Skills

• General Computer Skills

• Clinical Software

• Managed Care

Language (Other than English)

None

Travel Required

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$170,000.00

Pay Range Maximum:

$352,500.00

Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J267780

The Clinical Supervisor, Intake Services will facilitate, coordinate and evaluate the clinical services, operation and efficiency of the Assessment Services department. Their focus will be to ensure congruence in the management of the team and coordi Clinical, Supervisor, Intake, Mental Health, Service, Behavioral Health, Healthcare

*Description*

You will help support the Collectors and Leaders by processing and handling time sensitive documents and effectively maintaining office inventory. Attention to detail is crucial and above average data entry skills is a must.

* analyzing accounts to resolve balance discrepancies.
* data entry
* posting payments and adjustments
* Processing itemized bills from clients.
* Verify insurance eligibility.
* Inspect bankruptcy notifications.
* Accurately process all internal correspondence, account update and placement files in a timely fashion and be able to manage multiple deadlines at the same time.
* Assist with the development of tools that contribute to the efficiency and productivity of the entire Support Service team.
* Document and maintain procedures for all tasks.
* Coordinate, validate, and deliver consumer specific request. (Example: analyzing consumer mail or itemized billings for accuracy and need)
* Opening the daily mail
* General correspondence review
* Reviewing itemized statements from client
* Consumer dispute resolution

*Skills*

data entry, claims resolution, patient information, medical insurance, claims processing, Document management, itemized billing, disputes and litigation, administrative support, Data, data entry

*Top Skills Details*

data entry,claims resolution,patient information,medical insurance,claims processing,Document management,itemized billing,disputes and litigation

*Additional Skills & Qualifications*

Qualifications:
- Excellent computer skills, proficient in Microsoft Outlook, Word, and Excel
- Demonstrates commitment to exceptional professionalism, confidentiality, and service to customers.
-Ability to identify and solve problems.
-Knowledge of HIPAA, Medicaid, Medicare, Insurance and FDCPA is a plus
* Superior mathematical skills that include advanced accounting skills (i.e., Invoicing and processing of statements).
* Superior proficiency in Microsoft Office products (Word, Excel, PowerPoint, etc.)
* Ability to adjust to changing agency priorities.
* Ability to recognize the need for, and maintain levels of, confidentiality as needed in leadership functions.
* Excellent organizational skills; must be able to efficiently manage a variety of projects and customer needs simultaneously.

*Experience Level*

Intermediate Level
*Pay and Benefits*
The pay range for this position is $16.00 - $16.00/hr.
Eligibility requirements apply to some benefits and may depend on your job
classification and length of employment. Benefits are subject to change and may be
subject to specific elections, plan, or program terms. If eligible, the benefits
available for this temporary role may include the following:
* Medical, dental & vision
* Critical Illness, Accident, and Hospital
* 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
* Life Insurance (Voluntary Life & AD&D for the employee and dependents)
* Short and long-term disability
* Health Spending Account (HSA)
* Transportation benefits
* Employee Assistance Program
* Time Off/Leave (PTO, Vacation or Sick Leave)
*Workplace Type*
This is a fully onsite position in Indianapolis,IN.
*Application Deadline*
This position is anticipated to close on Aug 31, 2025.
h4>About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

About TEKsystems and TEKsystems Global Services

We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Facility: OrthoIndy Hospital Northwest,Indianapolis, IN Department: OI Support ServicesShift Details: Full-time hourly, Monday-Friday 8 am - 5 pm; Training in-office for 90 days, then 100% remote.At OrthoIndy everythingwe do is about creating a caring, connected and committed workforce thatdirectly improves the quality of life for our employees and customers.Be part of something great!At OrthoIndy, we provideleading-edge bone, joint, spine and muscle care from 13 OrthoIndy locationsthroughout Central Indiana, staying true to our mission and our patients byoffering a full range of procedures and treatment options. We have over80 physicians in our practice and we continue to be one of the most highlyrespected and trusted orthopedic practices in the Midwest. OrthoIndy hasreceived national recognition for patient safety and orthopedic excellence andour philosophy is a physician-owned hospital model where patients experiencesuperior service, safety and patient satisfaction because physicians areinvolved in every aspect of your care. General Statement of Duties:The Clinical PatientServices Coordinator is the providers first line to the extension of theirclinical practice and the patients' primary point of contact. The PatientService Coordinator serves as the main point of contact for assignedPhysicians. The Coordinator establishes a patient friendly environment tofacilitate communication between patients and OrthoIndy. Primary areas of focusinclude surgery or procedural scheduling, triage of patient questions and dailyproblem solving to ensure patients expectations and needs are met.Essential Duties:Schedule all surgical procedures at designated facilities. Obtains and schedules any medical clearance needed when applicable. Schedules 1st post-operative appointments. Schedules first physical or occupational therapy appointments following surgery.Responsible for managing surgery schedule including case order according to surgical procedure. Communicating to all patients' pre-operative instructions and arrival time.Triages all patients concerns related to symptoms and treatment. Constant communication with provider regarding patient care recommendations.Manages patient prescription refill requests.Arranges provider peer to peer reviews when applicable.Manages provider schedule and all tasks related to patient care and documentation in EMR. Communicates with scheduling department on days providers are out of office and last-minute template changes.Schedules appointments for patients. Serves as back up to appointment scheduling to specialty team when call volume is high.Learning assigned providers specialty type. Treatment approach both conservative and surgical. Pre and post op protocols per surgical procedure. Treatment progression for episode of care. Payer clinical guidelines for required treatment for surgical candidates for prior auth department to obtain authorizations for surgery.Works closely with prior authorization team for surgical or procedural authorization.Assist in coordination of referrals ordered by assigned provider.Requirements:High school diploma or general education degree (GED) required.Athletic trainer, LPN or Medical Assistant certification required.2-4 years of healthcare experience required; 4-6 years preferred.Spine experience preferred.Basic Life Support (BLS) preferred.OrthoIndy is an Equal Opportunity Employer

• Collaborate with cross-functional partners to understand the Ancillary Supply needs.
• Translate Ancillary Supply demand to a global sourcing strategy and influence the sourcing decision.
• Design operational plans based on clinical requirements, ancillary supply sourcing strategy, and partnership with clinical study team.
• Responsible for the completion of all documentation that defines the operational plan such as but not limited to supply templates, work orders, and item listings and tools that define trial budgets and timelines.
• Responsible for the delivery and closeout of Ancillary Supply operational plans on time, on budget, and within scope.
• Manage supply dispensation plan to support global delivery of Ancillary Supplies.
• Proactively manage distribution to sites to ensure on time delivery and resolve issues with sites and partners/vendors as they arise.
• Collaborate with PR&D Quality to ensure compliance by creating and routing change controls, dispositions, problem reports, undeliverables, Quality Notifications, Notifications to Management as well as documentation for support of processes outside of the established Ancillary scope.
• Maintain expertise in the use of electronic data management and enterprise systems such as Quality Docs, SAP, SharePoint, and Teams Sites.
• Maintain local tools in support of consistent delivery of Ancillary Supplies.

• Establish and manage external partner and vendor relationships.
• Build compliance into business partner/vendor processes and activities. Provide feedback and training to partners/vendors as appropriate to continuously improve compliance.

• Define, lead, and implement plans to develop and improve Ancillary Supplies strategies, technologies, and processes.
• Interact with global customers (internal and external) on business issues related to the delivery of Ancillary Supplies.

• Bachelor's degree in Pharmacy, Engineering or scientific related field or equivalent work experience.
• 5+ years of experience in at least one of the following: clinical research, distribution, supply chain, logistics, clinical trial materials, project management, or direct quality support for any of these areas.

• Knowledge of the pharmaceutical industry, drug development process, and supply chain practices.
• Knowledge and/or experience in project management.
• Proficient in computer technology used in office and scientific areas, such as Word, Excel, SAP, and molecule databases.
• Proficient in managing SharePoint lists, libraries, and Microsoft teams.
• Experience working with third parties.
• Strong attention to detail.
• Ability to work independently and effectively manage competing priorities.
• Ability to adapt to a changing environment.
• Good interpersonal and leadership skills.
• Excellent oral and written communication skills.
• Demonstrated strength in logical thought, problem solving ability, and critical thinking.
• Ability to communicate and influence across functional boundaries.
• Knowledge of regulatory and/or quality requirements governing clinical development.
• Knowledge of GxP regulations and requirements (GMPs, GDPs and/or GCPs).
• Experience in deviation and/or change management.
• Language Requirements: Must speak fluent English.
• Indianapolis based.
• 10% or less travel.

1. Evaluates the quality and effectiveness of clinical practices and services. Analyzes internal and external data and identifies opportunities for improving services and patient outcomes. Promotes and monitors regulatory guidelines and customer service expectations for all nursing aspects. Operationally and fiscally manages the department. Assess and responds appropriately to organizational culture.
2. Ensures compliance with the following but not limited to: organizational policies and procedures, HIPAA, infection prevention, accreditation standards, governmental regulations, and professional standards of care.
3. Monitors patient medical records for accuracy. Retrieves data and prepares reports as directed, i.e. quality assurance, risk management, etc.
4. Manages the schedules for all staff to meet the needs of the business. Coordinates all necessary breaks and manages time off approvals to ensure adequate coverage is maintained. Holds staff accountable for attendance. Participates in staffing to maintain clinical skills and to role model appropriate behaviors and be visible to staff and physicians.
5. Serves as a role model and resource for staff. Demonstrates effective communication, consultation, negotiation, and collaboration skills with all members of the perioperative team. Conducts regular staff meetings to promote open communication and accountability.
6. Responsible for assisting Human Resources in retention and recruitment. Conducts timely performance reviews and goal setting for department employees. Effectively addresses personnel issues by providing timely guidance, support, and constructive feedback to promote a positive productive work environment.
7. Aids in developing and addressing educational needs designed to elevate the staff to an expert level of nursing and to promote continuous learning. Directs and assists personnel in their orientation and training. Ensures that educational resources are available for implementation of new technology or when adopting new practices related to policy or procedure. Incorporates and assists staff members with assimilating evidence-based knowledge into decisions for the provision of safe patient care.
8. Demonstrates fiscal responsibility in staffing and supply use. Participates in the creation of department budgets and variance management. Ensures operation of department within the approved budget.
9. Ensures availability and operation of necessary equipment and supplies for patient care.

• Bachelor of Science in Nursing required from a nationally accredited nursing program
• Registered Nurse license required
• CNOR certification required
• 4-6 years of related experience required, 6-8 years of experience preferred
• BLS and ACLS certification required