Benefits & Authorization Specialist

Macomb County Community Mental Health; Clinton Charter Township (MI); On-site; USD 60,000 - 75,000; Full time

Job summary

Macomb County Community Mental Health seeks a clinical professional to coordinate referrals, determine eligibility, review service requests, and ensure medically necessary authorizations align with benefits and organizational policies.

The role involves liaison work with providers, completing required documentation, and contributing to program improvement while complying with Michigan regulations.

Qualifications

• Master’s degree in social work, Counseling, Psychology or Doctorate in Psychology or a directly related mental health field from an accredited college or university.
• Two (2) years of clinical experience working in a mental health setting.
• One (1) or more years' experience in utilization management.
• One (1) or more years’ experience with an electronic medical record system from Peter Chang Enterprises (PCE).
• Licensed Master Social Worker (LMSW), LLMSW, Licensed Professional Counselor (LPC), LLPC, Temporary Limited Licensed Psychologist (TLLP), Limited License Psychologist (LLP), or Licensed Psychologist (LP).
• Possession of a valid Michigan driver's license and operable automobile for authorized travel.

Responsibilities

• Review member benefit plans and authorization requests to determine coverage eligibility, benefit availability.
• Conduct brief reviews, document findings, and ensure authorization requests are processed per regulations and policies.
• Collaborate with providers to obtain information for benefit verification and authorization processing.
• Complete case documentation following MCCMH policies and procedures.
• Identify trends and opportunities for service and process improvement.

Education

Master’s degree in social work, Counseling, Psychology or Doctorate in Psychology or a directly related mental health field

Two (2) years of clinical experience working in a mental health setting

One (1) or more years' experience in utilization management

One (1) or more years’ experience with an electronic medical record system from Peter Chang Enterprises (PCE)

Licensed Master Social Worker (LMSW), LLMSW, LPC, LLPC, TLLP, LLP, or LP

Valid Michigan driver's license

Ability to meet privileging and credentialing guidelines

LMSW/LPC/LP as preferred licenses

Job description

Macomb County Community Mental Health seeks a clinical professional to coordinate referrals, determine eligibility, review service requests, and ensure medically necessary authorizations align with benefits and organizational policies.

The role involves liaison work with providers, completing required documentation, and contributing to program improvement while complying with Michigan regulations.