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Behavioral Care Advocate
Fairview Health Services
Overview The Behavioral Care Advocate reviews clinical documentation to determine appropriate level of care and authorization as needed. Additionally, for providing clinical case management activities across the continuum of care from assessing to coordinating, monitoring and evaluating. This position provides telephonic education and quality monitoring. Understands case management philosophy and principles the role of utilization management, its philosophy and principles. Obtain the necessary knowledge of regulatory standards and Level of Care guidelines established by CMS and community standards. Provide utilization review services through review of outpatient behavioral health treatments for medical necessity and quality of care. Conducts authorization, concurrent review, coordination and assurance that members are at an appropriate level of care. Focus on utilization review of behavioral health and substance abuse services. Coordinating benefits and transitions between various areas of care. Identifying ways to add value to treatment plans and consulting with facility staff on those ideas. Reviewing cases and analyzing clinical information in conjunction with Medical Directors to determine the appropriateness of level of care and ensure documentation meets payer and regulatory requirements. Escalating cases to the Medical Director for case discussion or peer-to-peer intervention as appropriate.
Required Qualifications:
Preferred Qualifications:
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