Clinical Eligibility Specialist

Job Description

Job Description

The Clinical Eligibility Specialist “CES” primary role is to assess potential clients through the use of standardized clinical instruments to inform the Clinical & Admissions teams on their suitability for care within the facility. We are seeking a highly skilled and detail-oriented Clinical Eligibility Specialist to join our dynamic healthcare team. The Clinical Eligibility Specialist will be responsible for evaluating patient eligibility for various healthcare programs, ensuring compliance with regulatory requirements, and facilitating the enrollment process. The successful candidate will possess a strong understanding of healthcare regulations, and excellent analytical skills. The CES should be a knowledgeable clinician who is familiar with multiple modalities of treatment, is proficient with clinical assessment, and demonstrates strong competencies in interdepartmental communication, familiar with a wide array of mood and other mental health disorders, and can document the findings during these assessments where appropriate.

ABOUT US :

A Mission For Michael is Different. We believe in going beyond traditional mental health care by offering a more personal, deeply compassionate healing experience. Nestled in beautiful residential homes, our dedicated clinical team provides 24 / 7 care in a safe and supportive boutique setting with 6-8 clients per home. Our comprehensive clinical programming blends individual and group therapy with experiential therapies such as art, music, and equine therapy. In addition to psychological evaluations, we prioritize getting to know each client’s life story and personal history. This insight into their lived experience helps us craft a treatment plan that is as unique as they are, ensuring we address not just their symptoms, but the root causes of their struggles.

We are tenacious in making sure every client feels seen, heard, and cared for, with their well-being serving as our true north. A Mission for Michael’s long-standing presence in the mental healthcare field and our well-earned reputation for excellence gives families confidence that their loved one is in trusted, credible hands. Our history reflects our deep commitment to quality care and consistent, positive outcomes.

This position is 100% remote eligible.

BENEFITS :

Medical, Dental, and Vision plans through Anthem.

FSA / HSA Accounts.

Life / AD&D insurance through Anthem, 100% paid for by the employer.

Other benefits include :

401k plan with employer match.

PTO, Self Care Day, and Floating Holiday.

Educational Assistance Reimbursement Program.

Employee Assistance Program.

Health and Wellness Membership.

QUALIFICATIONS :

To perform this job successfully, an individual must be able to perform each essential job function assigned satisfactorily. The requirements listed above are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Education Requirements : Bachelor's degree or 2 years of mental health professional experience.

Must be 18 years or older to apply for this position.

Must be able to pass an ADP Criminal Background Screen.

Proficient multi-tasking capabilities with excellent communication skills and a positive attitude

Physical Requirements : Ability to work on a computer / keyboard, use electronic systems, communicate with others through written and verbal formats, ability to sit for long periods of time, listening, reading comprehension, lifting up to 10 lbs.

Knowledge, Skills, and Abilities :

Thorough understanding of symptoms exhibited with common substance use and mental health disorders and ability to differentiate between the various criteria as delineated in the DSM V and ICD-10.

Proficiency in conducting Pre-Assessments to measure suitability of clients for admission.

Thorough understanding of medication protocols, side effects, and adverse reactions.

Ability to document notes effectively via the organization's Electronic Health Record system (EHR.)

Proficient multi-tasking capabilities with excellent communication skills and a positive attitude while maintaining positive and friendly interpersonal relationships with coworkers from various departments and backgrounds, maintaining professionalism at all times.

Excel at both written and verbal communications, able to send emails and communicate in a professional, appropriate tone to convey essential information; must be able to utilize the proper linguistic syntax and spelling.

RESPONSIBILITIES :

The Clinical Eligibility Specialist I is the first clinician to assess the prospective admit after their financial and other eligibility criteria has been met..

Thoroughly conduct a mental health and clinical assessment of the client in order for the organization to gain full awareness as to the potential suitability for the client to admit.

Competently assess the prospective client in multiple axes to ascertain their current mental and physical state, including but not limited to the following criteria :

Suicidality, prior suicide attempts, current level of suicidal ideation (if applicable)

History of drug use, previous overdoses, and past treatment episodes

Psychiatric stabilization history, history of violent or otherwise aberrant behavior

Acute medical conditions

Report clients state self pain rating at time of assessment

History of any abuse, trauma, or neglect

Current mental health or physical health symptoms

Active and past medications and abbreviated psychotropic medication history

Collateral family information

Legal history

Make appropriate recommendations to which level of care the prospective client would require, and communicate to the client that information so the client can make an informed decision as to whether they would like to proceed with seeking admissions into AMFM Healthcare’s programs.

Be familiar with all of AMFM Healthcare’s programs and services so that correct information can be relayed to the client of what their treatment episode here would entail.

Proficiency and knowledge of the Biopsychosocial assessment, ASAM criteria, and other criteria as outlined in organizational policy.

Maintain the record of care in all prospective clients EHR’s in accordance with company policy, Joint Commission accreditation requirements, and CA-DHCS guidelines.

Closely documenting risk of clients that are heightened suicide risks

Liaise with the Business Development and Admissions departments effectively, be an effective conduit of information transfer

Demonstrate availability and willingness to conduct pre assessment screening and client contact calls throughout the week in order to facilitate smooth admissions of prospective clients.

Other job duties as assigned by the Executive Clinical Director.

AMFM Healthcare is committed to providing equal employment opportunities to all employees and applicants without regard to race, ethnicity, religion, color, sex (including childbirth, breast feeding and related medical conditions), gender, gender identity or expression, sexual orientation, national origin, ancestry, citizenship status, uniform service member and veteran status, marital status, pregnancy, age, protected medical condition, genetic information, disability, or any other protected status in accordance with all applicable federal, state and local laws.