Member Advocate III Part-Time

Horizon Health (NASDAQ/NM: HORC) is a diversified health care services provider. It is the largest behavioral health care contract management company in the United States. The company also has successful operating subsidiaries in physical rehabilitation, managed health care, employee assistance plans, and nurse staffing. We employ highly educated, dynamic individuals that contribute substantially to our company’s success. Expanding operations, recent acquisitions, and an acquisitive growth plan have created excellent opportunities for qualified candidates.We are proud to be #58 on Forbes Best 200 Small Companies in America for the past three years!
Horizon Health Corporation offers employees an exceptional employee benefits package, which includes:• A Health Care Plan with medical, dental and pharmacy coverage is available at reasonable monthly rates.• Supplemental Life Insurance is available for self, spouse, or dependent.• Disability Insurance is included for both short and long term duration.• A Flexible Benefit Plan is available with a tax reduction feature for health and dependent care expenses.• A 401 (k) Retirement Plan is available.These and other benefits, a competitive salary, and career opportunities are available to each employee that joins the Horizon Health Corporation team.Summary of Major Functions:This Licensed Professional will act as the primary liaison between member and services provided. Guides members through system by performing the following duties.Part-time Hours
7 P.M. to 12 A.M, M-F
REQUIREMENTS
Essential Duties and Responsibilities include the following. Other duties may be assigned
1. Receive calls from clients requesting information or seeking to access Horizon services.
2. Completes on-line Intakes, confirm benefit information.
3. Using structured guidelines, identify cases that require immediate Case Management intervention.
4. Provide supportive telephone consultation to members in distress
5. Record client’s requests for information regarding Horizon benefit, medical insurance coverage, referral process, and out-of-network services;6. Respond to Client Requests for Information: receive inquiries/requests, use appropriate resources to obtain relevant information, contact clients to provide information, document information provided.
7. Identify eligible and appropriate network providers for client referrals;8. Maintain records explaining placement efforts
9. Complete Service Authorization Forms for distribution to providers and communicates procedural information to providers;
10. Complete a process of confirming appointment dates and times to assure that appropriate placement has been made.
11. Refer clients to community resources. Locate resources for members where these are lacking. Maintain and keep current a list of toll free numbers for national support groups, self-help programs, etc.
12. Generate provider lists in response to client requests13. Perform Initial and Concurrent Reviews with facilities for higher levels of care using ASAM and UR criteria.
14. Complete appropriate follow-up with Members and Providers/Facilities.EOE