Advanced Behavioral Health, Inc - ABH

POSITION SUMMARY:  An Intensive Care Manager is responsible for assisting clients identified with severe mental illness who reside in a nursing home level of care, and are interested in leaving such nursing home level of care, to return to the community of their choice. The ICM is responsible for coordinating their recovery support and behavioral health services with other aspects of their care in the community.  Community clients who are identified with severe mental illness and at risk of being placed in a nursing home level of care may also be assisted by an Intensive Care Manager if needed. The ICM is responsible for completing assessments and coordinating discharge plans.  The Intensive Care Manager is responsible for creating initial recovery plans and updating these plans at prescribed intervals.  An Intensive Care Manager is expected to bring a level of clinical leadership to the WISE Program.  This position will represent ABH® and its services in a positive and professional manner and adhere to ABH®’s best practices, guidelines, policies and procedures as established, promoting ABH® as a leader in behavioral healthcare in all interactions and work. DUTIES AND RESPONSIBILITIES: - Assumes responsibility for a designated client case load; - Travels statewide to assess and evaluate potential clients eligible who are residing in nursing homes and who are candidates for transitions back to the community; - Completes all MFP/DSS paperwork as required; - Works as part of a team providing clinical expertise and knowledge to the other clients of the team; - Conducts all recovery plan reviews, service authorizations and care coordination (or oversight and supervision) for all assigned clients; - Maintains an understanding of behavioral health benefits and remains current on covered benefits, limitations, exclusions, and policies and procedures, in regards to services; - Supervises collection of information regarding the delivery and outcomes of services to clients, and uses that information to recommend modifications to plan policies and procedures which improve the delivery of services to clients; - Provides clients, providers, and other stakeholders with accurate and timely information concerning waiver benefits and coverage; - Works with clients and providers to customize services to best meet client’s needs within the scope of the program; - Works to assure that systematic revisions to improve services are developed and implemented; - Coordinates, reviews and maintains daily logs for reporting purposes and for weekly preparation and analysis of trending reports; - Assists with coordinating information and making presentations to participating providers, state and federal agencies, community groups and other interested parties; - Facilitates linkages for clients and families between primary care, behavioral health providers and other social service or provider agencies as needed to develop and coordinate service plans; - Collaborates with providers and others in order to conduct diagnostic screenings for substance abuse, mental health, co-occurring disorders and triage the referrals to appropriate waiver and/or treatment services, initial assessment, treatment planning and aftercare planning for clients; - Assists assigned clients with smooth transitions when moving into or out of the community; - Monitors and evaluates the effectiveness and outcome of treatment and service plans, and recommends modifications as necessary to provide optimal clinically appropriate services with a goal of maintenance in the community at the least restrictive level of care; - Attends case conferences, interagency and provider treatment planning meetings for assigned clients; - Utilizes supervision with Lead Intensive Care Manager regularly; - Lends clinical expertise to WISE program staff; - Participates in professional development activities; - Attends annual Conflict of Interest training; - Attends training specific to job duties; - Maintains confidentiality of all client protected health information and adheres to all HIPAA related policies and procedures; - Demonstrates ethical behavior and cultural sensitivity in all activities involving individuals of diverse backgrounds; - Performs other tasks/responsibilities as required to support the business operations.

Title: Part Time Claims Coordinator Location: Middletown, Connecticut, United States Department: Operations Job Description: Description POSITION SUMMARY: Claims Coordinator Behavioral Health Claims & Managed Care | Part-Time | Hybrid | Middletown, CT – must be a CT resident About ABH ABH has been a cornerstone of Connecticut's behavioral health system partnering with state agencies, providers, and communities to strengthen access and quality of care across the state. As a nonprofit, we're driven by our mission. We manage mental health and substance abuse services, provide customized technology to operate programs efficiently, and participate in research representing best practices in the field. Behind all of it is a dedicated team making sure the operational and financial infrastructure runs the way it should and that's where this role comes in. If you are passionate about making a difference, aligned with our mission, and looking for a part-time opportunity that offers the flexibility to fit your life, we'd love to have you on our team. DUTIES AND RESPONSIBILITIES: - Process and adjust claims for the BHRP-Clinical, BHRP-Basic, Military Support, and Pre-Trial Intervention programs - Conduct weekly claims audits with emphasis on high-dollar submissions and compile audit reports - Manage check runs and eligibility file uploads as needed - Assist with weekly and monthly financial reporting - Support the claims denial review process and special claims projects - Respond to provider and staff inquiries about claims status, eligibility, and benefits - Assist in training new and existing claims staff - Maintain working knowledge of CPT and ICD-10 codes, behavioral health insurance terminology, and HCFA/UB-04 claim form requirements - Uphold confidentiality of all protected health information in accordance with HIPAA policies Work Arrangement CT residence only - This is a part-time, hybrid position offering real flexibility. Much of this role's work can be performed remotely, and we support work-from-home when responsibilities and workflows allow for it. Why Join ABH - Part-time schedule with genuine work-life flexibility - Hybrid work arrangement with meaningful WFH opportunity - Contribute to a mission-driven nonprofit that has been a cornerstone of Connecticut's behavioral health system - Collaborative team environment at a stable, established organization - Opportunities for growth across a diverse range of programs and functions ABH is an equal opportunity employer committed to a diverse and inclusive workplace. Requirements EDUCATION AND EXPERIENCE REQUIREMENTS: - Associate’s degree/Bachelor’s preferred in business or related field preferred; - Three years of demonstrated work experience in claims processing or in the behavioral health customer service field; - Attends trainings specific to job duties; - Attends annual Conflict of Interest. KNOWLEDGE/SKILLS/ABILITIES: - In-depth knowledge of ABH’s various utilization management and claims systems created by ABH and used by all the GA staff; - Must be flexible in order to respond quickly and positively to shifting demands; - Strong attention to detail; ability to work on multiple tasks and meet deadlines; - Excellent PC skills with demonstrated experience using Microsoft Office Package (MS Word, Excel, Outlook); - Strong written and verbal communication skills required. - Due to the need for in-person client support across Connecticut, this position requires residency within the state.

The Recovery Specialist provides and coordinates a full array of outreach-based services for clients in the DMHAS/ABH Behavioral Health Recovery Program. The primary goals of the program are to: 1) Improve clinical linkages from one level of care to another, 2) Provide holistic services to maximize the likelihood of client success, 3) Decrease the ineffective use of acute treatment services, 4) Ensure successful client treatment outcomes and 5) Ensure the client receives quality treatment services in an appropriate treatment setting. This position will represent ABH® and its services in a positive and professional manner and adhere to ABH®’s best practices, guidelines, policies and procedures as established, promoting ABH® as a leader in behavioral healthcare in all interactions and work. DUTIES AND RESPONSIBILITIES: Provide full array of Recovery Specialist services, including services that assist clients in obtaining basic supports needed to improve their likelihood of success in recovery. Including, but not limited to, the following: - Outreach and engagement attempts with clients in various community settings, including clients’ home, shelters, soup kitchens.  Outreach efforts may include attempts to contact clients via visits and /or letters to last known address, phone calls, visits to shelters, soup kitchens, collaboration with DSS, other recovery managers, and visits to treatment agencies; - Service planning for non-clinical needs (e.g., housing, transportation); - Assistance with arranging transportation to treatment and other community supports appointments; - Transportation to essential appointments when no other arrangement is timely or/and practical and such transport can be safely achieved; - Assistance and advocacy in accessing extant community support services; - Assistance in accessing urgent and standard Recovery Supports Program supports; - Face to face supportive counseling; - Referrals and contacts with culturally relevant organizations and individuals such as the following, as needed, to establish and maintain adequate community supports: - Vocational Providers; - Housing agencies, landlords; - Health care providers; - Probation/Parole officers; - Crisis intervention services, hospital emergency departments; - Other appropriate support and treatment services; - Family members and other natural supports; - Interpreter services; - Faith Communities (e.g. churches, masjids, etc.); - Provide fully array of Recovery Specialist services, including services that guide the course of client treatment through various levels of care.  Including, but not limited to the following: - Assessment and referral to the appropriate level of care; - Intake appointment scheduling; - Review of treatment history; - Arrange and attend case coordination meetings with clients and treatment providers to assure that appropriate issues are being addressed in treatment; - Global treatment planning and notification of the ASO regarding specific treatment recommendations and the expected path of treatment through various levels of care; - Case coordination meetings for clients involved with multiple treatment providers and community supports; - Outreach and/or phone contact to acute service providers to participate in treatment and discharge planning with the client and provider; - Tracking participation in treatment through the ASO and with service providers; - Carry a cell phone during work hours (8 a.m. – 5 p.m.) and respond to any messages within 30 minutes of the message; - Carry a company issued laptop and jet pack and conduct face to face sessions using the EHR where possible. - Provide transportation to clients, using personal vehicles; - Work out of a regional office and attend regular regional and statewide meetings of all Recovery Specialists; - Abide by all State and Federal Confidentiality Regulations; - Comply and work towards goals established by DMHAS and ABH®; - Maintain internal communications -  notifying supervisors with all relevant client or program based information; - Document all case management activities within required time frame and in required format - including documentation of all client related activities into electronic database; - Submit data and reports as defined and within required time limits; - Attend all required staff, supervision and training meetings; - Maintain hard copy of clients’ records (i.e. ROI) with appropriate documentation and signatures; - Function as a team member of a regional and statewide team, including providing as needed coverage for other members of the team; - Maintains confidentiality of all client protected health information and adheres to all HIPAA related policies and procedures; - Demonstrates ethical behavior and cultural sensitivity in all activities involving individuals of diverse backgrounds; - Performs other tasks/responsibilities as required to support the business operations.