Sat & Sun, 12:30 am - 8:30 am

Description of Duties: Member Services Specialists, specifically for Highmark, are responsible for responding to Highmark Member, family member and provider inquiries and requests for services by providing information and initiating intake processes for certain levels of care. They are also responsible for maintaining solid Member, family member and provider relationships by responding to requests, questions and concerns with accuracy and professionalism in a prompt, courteous manner. They are the first point of contact for those accessing Highmark outside of business hours for Behavioral Health Services.

Qualifications Required: Associates degree in Human Service field preferred; will consider high school diploma with good customer service experience/background. 1 year prior experience in behavioral health/managed care/human services required or other background and experience that would translate well into this position. 1-3 years customer service and data entry experience required, preferably in call center environment. Previous telephone experience, preferably in call center environment. Previous experience in an office setting and/or doctor’s office/hospital preferred.

 

 

Shift: Wednesday – Friday 3:00 p.m. to 11:00 p.m. and Sunday 4:00 p.m. to 12:00 a.m.

Member Services Specialists are responsible for the intake processes of CBHNP. They are the first point of contact for Members accessing the company. This position is responsible for answering the telephone and explaining the operation of CBHNP to Members when they call; Completing intake information regarding the member; Explaining procedures for accessing services to Members; Coordinating/Interfacing with the Medical Assistance Transportation Program (MATP), as necessary, to assist Members in securing transportation to scheduled appointments; Completing bed searches, as necessary, for IP and SA bed requests; Addressing Member complaints through the initialization of the CBHNP Grievance and Complaint process; Explaining a Member's rights as requested; Providing additional resources to the Member such as a Member Handbook and list of in-plan providers from the Member's geographic region and completing data entry of requests and authorizations.

Bachelor's degree required. Excellent written and verbal communication skills with the ability to respond sensitively to members requests required. Previous customer service and data entry experience required preferably within a call center. At least one year of experience in mental health and/or human services required; or equivalent background and experience that would translate well into this position. Experience with PC's in a windows based environment required.

 

 

Description of Duties: This position will be a key person to the successful day-to-day operations of the Quality Improvement Department. The individual must have an understanding of the key functions of an MCO, be able to work efficiently and independently, as well as be able to appropriately keep the Quality Improvement Department organized administratively and operate efficiently. Position will report directly to the Director of Quality Improvement and provide heavy support to the Managers, Supervisors and Clinical Reviewers in the Quality Improvement Department in addition to providing support to the Chief Operating Officer, as needed.

Qualifications Required: High School Diploma or equivalent; Business school certificate or college degree strongly preferred. 3-5 years experience in professional office setting providing high level administrative support to one or more executives (preferably in the healthcare industry and corporate atmosphere); or equivalent combination of education and work experience; Experience performing independently and making independent decisions; Previous understanding, knowledge and experience working with an MCO; Previous experience working with Clinical Staff and/or Clinical Related work strongly preferred.

Excellent interpersonal skills; Demonstrated experience handling a variety of tasks simultaneously; Must be well organized and able to work under pressure; Ability to perform independently and make independent decisions that significantly impacts operations or pieces of business; Demonstrated ability to take minutes, write, edit and proofread written materials in a timely fashion; Understanding of behavioral health managed care, including the interaction between state, county, and MCO partners preferred; Ability to communicate well verbally and in writing; Pleasant telephone manner; Data entry experience; Ability to use PC’s in a Windows based environment. Proficient in MS office and experience with the Internet; Ability to work independently and maintain a high level of confidentiality.

 

 

Description of Duties: Under the direction of the Director, IT, this position is responsible for assuring integrated, scalable and efficient technology software systems that improve existing or meet new business process requirements for CBHNP. Responsible to define and analyze needs, design solutions, deliver outcomes and manage programming staff. Will oversee new or existing projects as required by the Director, IT. The scope of work and oversight includes functions normally performed by a Business Analyst, Software Engineer, Project Manager, Programmer, Quality Assurance Analyst and Technical Writer.

Qualifications Required: Bachelor’s degree in Computer Science or a related field and 5 years experience in a similar role OR an equivalent combination of education and work experience. Must have advanced knowledge of software development and the basic function and process of computers, networking and computer technology; 5 years of prior experience in programming computer systems or 6-8 years (if non-degreed); A minimum 3 years prior experience in supervision/management is required; Working knowledge of medical insurance and MA systems very helpful; Project management experience; 3 years experience in the full application development life cycle including user requirements gathering, design, development, testing, and deployment; Understanding of best practices for software development and programming techniques.

Expert encoding and object oriented programming skills with Microsoft supported languages, preferably VB.net; Expert database development skills, preferably with SQL; Strong leadership/supervisory skills; Strong presentation skills required. Ability to handle conflict and difficult situations; Ability to prioritize ongoing and new projects, direct, and delegate as well as conduct research and gather information as needed; Excellent interpersonal skills, both verbal and listening, to interact with other staff in assessing Information System needs, problem solving and program design; Ability to apply deductive reasoning and draw conclusions in order to solve problems and facilitate decision-making processes; Must be well versed in Microsoft Office products including but not limited to Word, Excel, Access, Outlook and Power Point.

 

 

Description of Duties: Responsible for understanding the Children’s Behavioral Service Delivery System and access to that system. Work closely with Member, Member’s family, and providers to determine appropriate level of care to meet treatment needs. Clinical Care Managers are responsible to ensure that treatment delivered is appropriately utilized and meets the Member’s needs in the least restrictive, least intrusive manner possible. Will maintain caseload. Non-Business hour On-call responsibilities as scheduled/needed.

Qualifications Required: Masters Degree in Social Work, Psychology, Nursing or related field, plus Professional License/Certification required. Excellent communication skills (verbal and written), and the ability to handle difficult situations in a professional manner required. Minimum of three years post-graduate clinical experience or equivalent combination of education and clinically related work experience. Minimum of one-year experience in Behavioral Health Rehabilitative Service Delivery System. Experience with CASSP. Knowledge base in Medicaid, Medicare and Commercial Managed Care Systems, as well as, CAC and Bilingual strongly preferred.

 

 

Shift: Monday - Friday 12:30 a.m. – 8:30 a.m.
Description of Duties: Member Services Specialists, specifically for Highmark, are responsible for responding to Highmark Member, family member and provider inquiries and requests for services by providing information and initiating intake processes for certain levels of care. They are also responsible for maintaining solid Member, family member and provider relationships by responding to requests, questions and concerns with accuracy and professionalism in a prompt, courteous manner. They are the first point of contact for those accessing Highmark outside of business hours for Behavioral Health Services.

Qualifications Required: Associates degree in Human Service field preferred; will consider high school diploma with good customer service experience/background. 1 year prior experience in behavioral health/managed care/human services required or other background and experience that would translate well into this position. 1-3 years customer service and data entry experience required, preferably in call center environment. Previous telephone experience, preferably in call center environment. Previous experience in an office setting and/or doctor’s office/hospital preferred.

 

 

Hours: Typically Monday – Friday, 8:30 a.m. – 5:00 p.m., however, it is emphasized that this position requires adjusting to meet families’ needs in scheduling meetings which can be outside of these hours. This is an exempt-level position with flexibility required to meet the needs of the Members and their families, as well as the department workflow for all CBHNP Products. Heavy Travel.
Description of Duties: The Field Care Manager (“FCM”) is responsible for understanding the Behavioral Health Service Delivery System, specific to the child and adolescent population, and access to that system. Clarify, educate, and collaborate with Member, Member’s family, providers, and other child serving entities in assessing behavioral health needs and appropriate level of care. Field Care Manager will work closely with the regional office in establishing protocols in attending Member treatment team meetings and will also coordinate with the corporate office / North Central Care Management Unit on case conferences, medical necessity determinations, and clinical documentation. Overall, this position is responsible to ensure that treatment delivered is appropriately utilized and meets the Member’s needs in the least restrictive, least intrusive manner possible while cognizant of regional practices and building partnerships.

Qualifications Required: Graduate degree from an accredited educational program in Social Work, Clinical/Counseling Psychology, or Nursing. Must be licensed to practice in the state of PA (Pennsylvania Licensure required). Minimum of two years post-graduate clinical experience or equivalent combination of education and clinically related work experience; Minimum of two-year experience in Behavioral Health Service Delivery System, specifically Behavioral Health Rehabilitation Services in a Master’s Level position; Minimum of one-year experience working with a managed care system preferred; Proven leadership experience strongly preferred; Knowledge base in Medicaid Managed Care Systems (preferably HealthChoices)

Strong written and oral communication skills with ability to work independently; Strong presentation skills with ability to lead team meetings; Ability to perform multiple tasks; Excellent interpersonal and organizational skills; Strong documentation skills; Ability to work effectively in a team environment; PC skills and experience utilizing Microsoft Office, Outlook, Excel, Power Point.

 

 

Shift: Wednesday – Sunday 4:00 p.m.- 12: 00 a.m.
Description of Duties: Member Services Specialists are responsible for the intake processes of CBHNP. They are the first point of contact for Members accessing the company. This position is responsible for answering the telephone and explaining the operation of CBHNP to Members when they call; Completing intake information regarding the member; Explaining procedures for accessing services to Members; Coordinating/Interfacing with the Medical Assistance Transportation Program (MATP), as necessary, to assist Members in securing transportation to scheduled appointments; Completing bed searches, as necessary, for IP and SA bed requests; Addressing Member complaints through the initialization of the CBHNP Grievance and Complaint process; Explaining a Member’s rights as requested; Providing additional resources to the Member such as a Member Handbook and list of in-plan providers from the Member’s geographic region and completing data entry of requests and authorizations.

Qualifications Required: Bachelor’s degree required. Excellent written and verbal communication skills with the ability to respond sensitively to members requests required. Previous customer service and data entry experience required preferably within a call center. At least one year of experience in mental health and/or human services required; or equivalent background and experience that would translate well into this position. Experience with PC’s in a windows based environment required.

 

 

Shift: Monday – Friday 12:00 p.m. - 8: 00 p.m.
Description of Duties: Member Services Specialists are responsible for the intake processes of CBHNP. They are the first point of contact for Members accessing the company. This position is responsible for answering the telephone and explaining the operation of CBHNP to Members when they call; Completing intake information regarding the member; Explaining procedures for accessing services to Members; Coordinating/Interfacing with the Medical Assistance Transportation Program (MATP), as necessary, to assist Members in securing transportation to scheduled appointments; Completing bed searches, as necessary, for IP and SA bed requests; Addressing Member complaints through the initialization of the CBHNP Grievance and Complaint process; Explaining a Member’s rights as requested; Providing additional resources to the Member such as a Member Handbook and list of in-plan providers from the Member’s geographic region and completing data entry of requests and authorizations.

Qualifications Required: Bachelor’s degree required. Excellent written and verbal communication skills with the ability to respond sensitively to members requests required. Previous customer service and data entry experience required preferably within a call center. At least one year of experience in mental health and/or human services required; or equivalent background and experience that would translate well into this position. Experience with PC’s in a windows based environment required.