Join arenaflex, a dynamic and esteemed healthcare organization, as a Care Representative Customer Service, where you will have the opportunity to make a significant impact on the lives of our members. In this vital role, you will oversee and evaluate Behavioral Health Treatment (BHT), including Applied Behavior Analysis (ABA) services, for eligible members, ensuring that they receive the highest quality of care based on medical necessity.
**About arenaflex**
arenaflex is a leading healthcare organization dedicated to providing exceptional care and service to our members. We are committed to fostering a collaborative environment that emphasizes high-quality performance and member service, nurturing a culture of dignity and respect. Our team is passionate about making a difference in the lives of our members, and we are seeking a talented Care Representative Customer Service to join our dynamic team.
**Job Overview**
As a Care Representative Customer Service, you will be responsible for navigating a mission-focused environment dedicated to excellence in member service and care management, demonstrating integrity and accountability. You will collaborate effectively with team members to fulfill departmental objectives and support both immediate and long-term goals. Your primary responsibilities will include:
* Assessing requests for medical appropriateness and verifying referrals according to established clinical guidelines
* Collecting pertinent medical information for review by the Medical Director and communicating decisions clearly
* Accurately documenting all necessary information in the utilization management system, ensuring updates on authorizations are recorded
* Conducting thorough reviews of submitted documentation for compliance with coding (ICD-10, CPT-4, HCPCS) and coverage guidelines
* Maintaining adherence to established policies and procedures while conducting quality reviews of documents
* Promptly notifying providers and members of decisions made, ensuring timely and effective communication
* Staying updated on federal, state, and local regulations pertaining to the BHT benefit
* Identifying potential quality concerns and reporting them as necessary, assisting with case audits when required
* Participating in additional projects and responsibilities as assigned
**Required Skills**
To succeed in this role, you will need to possess the following skills and competencies:
* Establish and nurture strong relationships with colleagues and external partners from diverse backgrounds
* Work autonomously while exercising sound judgment in decision-making
* Communicate effectively in both verbal and written formats
* Adapt to a flexible work schedule that may include evenings and weekends
* Exhibit strong organizational, analytical, problem-solving, and project management skills
* Prosper in a fast-paced work environment while managing multiple tasks simultaneously
* Inspire and motivate team members and external committees
* Demonstrate proficiency in Microsoft Office Suite (Word, Outlook, Excel, PowerPoint) and related applications
**Qualifications**
To be considered for this role, you will need to possess the following qualifications:
* A Master’s degree in psychology, social work, counseling, or a related field
* A minimum of four years of experience in providing ABA or mental health services, including clinical review and treatment plan oversight
* Current, unrestricted California license (LCSW, LPCC, LMFT, RN with BH experience, BCBA, or BCBA-D)
**Career Growth Opportunities**
arenaflex values your professional development and offers numerous opportunities for skill enhancement and career advancement within the healthcare sector. Our organization is committed to fostering a culture of growth and development, and we are dedicated to helping you achieve your career goals.
**Company Culture and Values**
We foster a collaborative environment that emphasizes high-quality performance and member service, nurturing a culture of dignity and respect. Our team is passionate about making a difference in the lives of our members, and we are seeking a talented Care Representative Customer Service to join our dynamic team.
**Networking and Professional Opportunities**
In this role, you will have the chance to collaborate with a dedicated team, enhancing your professional network and skillset in the healthcare community. arenaflex is committed to providing opportunities for professional growth and development, and we are dedicated to helping you achieve your career goals.
**Compensation and Benefits**
arenaflex offers a competitive salary commensurate with experience, as well as comprehensive health, dental, and vision insurance. We also offer a retirement savings plan with company matching contributions, generous vacation and paid time off policies, and a range of other benefits to support your overall well-being.
**Work Environment**
As a remote employee, you will have the flexibility to work from anywhere, at any time. arenaflex is committed to providing a supportive and inclusive work environment, and we are dedicated to helping you achieve your career goals.
**How to Apply**
If you are a motivated and dedicated individual who is passionate about making a difference in the lives of our members, we encourage you to apply for this exciting opportunity. Please submit your resume and a cover letter outlining your qualifications and experience.
**Equal Employment Opportunity**
arenaflex is an equal employment opportunity employer and welcomes applications from diverse candidates. We are committed to fostering a culture of inclusion and respect, and we are dedicated to providing opportunities for professional growth and development.
**Contact Us**
If you have any questions or would like to learn more about this opportunity, please do not hesitate to contact us. We look forward to hearing from you and exploring how you can contribute to our dynamic team.