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Behavioral Health Specialist (Temp)
<p class="MsoNormal"><span style="font-family: 'Red Hat Text';">It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.</span></p> <p class="MsoNormal"> </p> <p class="MsoNormal"><strong><span style="font-family: 'Red Hat Text';"> ***Multiple Temp Openings***</span></strong></p> <p class="MsoNormal"> </p> <p class="MsoNormal"><strong><span style="font-family: 'Red Hat Text';">Job Summary:</span></strong></p> <p class="MsoNormal"><span style="font-family: 'Red Hat Text';">The Behavioral Health Specialist is responsible for managing incoming prior authorization and inpatient admission requests for behavioral health services. This role involves reviewing submissions, gathering clinical documentation from providers, verifying member eligibility, and entering information into the Jiva system. The specialist ensures requests are routed appropriately to the clinical team, communicates determinations, resolves escalated issues, and collaborates closely with behavioral health clinicians to support timely and accurate decision-making.</span></p> <p class="MsoNormal"><strong><span style="font-family: 'Red Hat Text';"> </span></strong></p> <p class="MsoNormal"><span style="font-family: 'Red Hat Text';">Our Investment in You:</span></p> <p class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l2 level1 lfo1;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">Full-time remote work</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l2 level1 lfo1;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">Competitive salaries</span></p> <p class="MsoNormal"><span style="font-family: 'Red Hat Text';"> </span></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';">Key Functions/Responsibilities:</span></strong></p> <p class="MsoListParagraphCxSpFirst" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l3 level1 lfo2;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">Manages and prioritizes incoming behavioral health authorization and inpatient admission requests; processes designated services in accordance with departmental protocols and routes cases appropriately to the behavioral health clinical team.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l3 level1 lfo2;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">Verifies member eligibility and enters all required data into the Jiva system with accuracy and efficiency to ensure compliance with turnaround time standards.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l3 level1 lfo2;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">Communicates with healthcare providers to request, clarify, or follow up on clinical information necessary for authorization determinations.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l3 level1 lfo2;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">Oversees incoming requests received through Jiva, fax, and email, ensuring accurate data entry and consistent adherence to established workflows and quality standards.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l3 level1 lfo2;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">Consistently meets or exceeds productivity benchmarks while maintaining compliance with regulatory and internal turnaround time requirements.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l3 level1 lfo2;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">Notifies providers of authorization decisions, addresses escalated provider inquiries, and ensures clear, professional, and timely communication at all times.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l3 level1 lfo2;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">Collaborates with internal departments to enhance understanding of the authorization process and maintains up-to-date knowledge of departmental policies, procedures, and system functionalities.</span></p> <p class="MsoListParagraphCxSpLast" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l3 level1 lfo2;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">Actively participates in team functions, including case triage, shared inbox and voicemail management, and department meetings.</span></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';"> </span></strong></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';">Supervision Exercised:<span style="mso-bidi-font-weight: bold;"> </span></span></strong></p> <p class="MsoListParagraph" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l1 level1 lfo3;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">None</span></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';"> </span></strong></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';">Supervision Received:<span style="mso-bidi-font-weight: bold;"> </span></span></strong></p> <p class="MsoListParagraph" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l1 level1 lfo3;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">Direct supervision weekly</span></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';"> </span></strong></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';">Qualifications: </span></strong></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><em style="mso-bidi-font-style: normal;"><span style="font-family: 'Red Hat Text';"> </span></em></strong></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';">Education Required: </span></strong></p> <p class="MsoListParagraph" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l1 level1 lfo3;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">Associate’s Degree in Healthcare, Nursing, Social Work or related area, or the equivalent combination of training and experience is required.</span></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';"> </span></strong></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';">Education Preferred:</span></strong></p> <p class="MsoListParagraph" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l1 level1 lfo3;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">Knowledge of medical terminology.</span></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';"> </span></strong></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';">Experience Required: </span></strong></p> <p class="MsoListParagraph" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l1 level1 lfo3;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">A minimum of 2 years of experience in a high-volume healthcare office, hospital administration, data entry office, or customer service call center. </span></p> <p class="MsoNormal"><strong><span style="font-family: 'Red Hat Text';"> </span></strong></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';">Experience Preferred/Desirable:</span></strong></p> <p class="MsoListParagraphCxSpFirst" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l1 level1 lfo3;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">Familiarity with Jiva, FACETS, or other healthcare databases. </span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l1 level1 lfo3;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">Experience working in health plan utilization or claims processing.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l1 level1 lfo3;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">Previous customer service experience is desirable.</span></p> <p class="MsoListParagraphCxSpLast" style="margin-left: 59.0pt; mso-add-space: auto; text-indent: -23.0pt; mso-list: l1 level1 lfo3;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">Behavioral Health experience.</span></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';"> </span></strong></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';">Required Licensure, Certification or Conditions of Employment: </span></strong></p> <p class="MsoListParagraph" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo4;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">Pre-employment background check</span></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';"> </span></strong></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';">Competencies, Skills, and Attributes: </span></strong></p> <p class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo4;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">Proven ability to prioritize and manage multiple tasks in a fast-paced environment while meeting deadlines.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo4;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">Capacity to process high volumes of requests accurately.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo4;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">Excellent listening, verbal, and written communication skills and a strong customer service focus</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo4;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">Teamwork and collaboration skills. </span></p> <p class="MsoListParagraphCxSpLast" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo4;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text';">Proficiency in Microsoft Office products.</span></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';"> </span></strong></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';">Working Conditions and Physical Effort: </span></strong></p> <p class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l4 level1 lfo5;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">Regular and reliable attendance is an essential function of the position. </span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l4 level1 lfo5;"><a name="_Hlk182906563"></a><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">Flexibility to work overtime during peak periods.</span></p> <p class="MsoListParagraphCxSpLast" style="margin-left: .75in; mso-add-space: auto; text-indent: -.25in; mso-list: l4 level1 lfo5;"><span style="mso-bookmark: _Hlk182906563;"><!-- [if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><!--[endif]--><span style="font-family: 'Red Hat Text'; mso-bidi-font-weight: bold;">Position is fully remote, with no or very limited physical effort needed and minimal exposure to physical hazards.</span></span></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';"> </span></strong></p> <p class="MsoNormal"><strong><span style="font-family: 'Red Hat Text';">Compensation Range </span></strong></p> <p class="MsoNormal"><span style="font-family: 'Red Hat Text';">$23.08 - $32.45</span></p> <p class="MsoNormal"><span style="font-family: 'Red Hat Text';">This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. </span></p> <p class="MsoNormal"><strong><span style="font-family: 'Red Hat Text';">Note</span></strong><span style="font-family: 'Red Hat Text';">: This range is based on Boston-area data, and is subject to modification based on geographic location. </span></p> <p class="MsoNormal"><span style="font-family: 'Red Hat Text';"> </span></p> <p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: 'Red Hat Text';">About WellSense</span></strong></p> <p class="MsoNormal"><span style="font-family: 'Red Hat Text';">WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.</span></p> <p class="MsoNormal"><span style="font-family: 'Red Hat Text';"> </span></p> <p class="MsoNormal"><span style="font-family: 'Red Hat Text';">Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees</span></p>