103 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

• Master's degree in social work, psychology, counseling or a directly-related human service field from a college/university accredited by the US Department of Education required
• Two (2) years related work experience in clinical assessment and treatment planning required; supervisory experience highly preferred
• Experience with Crisis Intervention, highly preferred
• Knowledge and application of utilizing social service systems (Medicaid, Social Security, Corrections, etc), highly preferred
• Community Mental Health experience, highly preferred
• Experience with MRO and Recovery Works programming, a plus

• Must be recognized as a Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC) or Licensed Marriage and Family Therapist (LMFT) by the State of Indiana

• Deep personal commitment to the Mission, Vision, and Values of Aspire Indiana Health
• Strong ability to maintain strict confidentiality and handle highly confidential information with professionalism
• Ability to be flexible and work outside normal business hours, as needed
• Must be able to work independently as well as collaboratively within a team setting
• Must have excellent collaboration and supervisory skills, and exceptional soft skills, such as relationship-building, teambuilding, interpersonal communication, problem solving, listening, negotiation, diplomacy
• Must possess/maintain a valid driver's license, current automobile insurance and a driving record that meets the guidelines and requirements of the organization
• Must have reliable transportation to oversee programming and/or attend trainings and/or meetings

• Group Medical (PPO and HSA Plans)
• Affordable visits, labs, and prescriptions through Aspire Indiana Health clinics
• Health Savings Account
• Group Dental and Vision Plans
• Prescription coverage, including low copays on all covered medications through select pharmacy locations
• Employee Wellness Program
• Group Life, AD&D Insurance
• Long Term Disability
• Short Term Disability
• Paid-Time Off (PTO)
• Paid Holidays
• Paid Bereavement
• Retirement Plan with generous employer match - Up to 6% match
• Employee Referral Bonus Program
• Your Money Line Financial Wellness Program

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.