Remote Care Representative – Customer Service & Member Support Specialist for Behavioral Health Services

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About careerzynith

careerzynith is a leading, purpose‑driven organization dedicated to transforming the delivery of behavioral health care across the United States. With a mission to empower individuals and families affected by mental health challenges, careerzynith blends cutting‑edge clinical expertise, data‑driven decision making, and a compassionate member‑first philosophy. Our remote workforce spans every time zone, allowing us to meet members where they live, work, and learn. As a member of the careerzynith team, you will be part of a culture that values integrity, collaboration, continuous learning, and the relentless pursuit of excellence in care.

Position Overview

careerzynith is seeking a highly motivated Remote Care Representative – Customer Service & Member Support Specialist to join our growing behavioral health division. In this role you will serve as the primary point of contact for members, families, and providers, ensuring that every interaction reflects careerzynith’s commitment to quality, empathy, and compliance. You will evaluate Behavioral Health Treatment (BHT) requests, including Applied Behavior Analysis (ABA) services, verify medical necessity, and communicate decisions clearly and compassionately. This is a fully remote, full‑time position that offers flexibility, professional growth, and the satisfaction of making a tangible difference in the lives of those we serve.

Key Responsibilities

• Navigate a mission‑focused environment dedicated to excellence in member service and care management, consistently demonstrating integrity and accountability.
• Collaborate with interdisciplinary teams—including clinical reviewers, medical directors, and provider networks—to meet departmental objectives and support both immediate and long‑term strategic goals.
• Assess incoming requests for medical appropriateness, verify referrals, and ensure alignment with established clinical guidelines and state‑mandated regulations.
• Collect, organize, and submit pertinent medical information for review by the Medical Director, then communicate authorization decisions in a clear, timely, and empathetic manner.
• Accurately document all interactions, authorizations, and case notes within careerzynith’s utilization management system, maintaining rigorous data integrity and audit readiness.
• Conduct comprehensive reviews of submitted documentation for compliance with coding standards (ICD‑10, CPT‑4, HCPCS) and coverage policies, identifying any discrepancies or gaps.
• Maintain strict adherence to careerzynith policies, federal, state, and local regulations, and industry best practices while performing quality reviews of all case files.
• Promptly notify providers and members of decisions, ensuring that any required follow‑up actions are clearly outlined and supported.
• Stay current on evolving BHT benefit regulations, emerging ABA best practices, and changes to reimbursement models to provide informed guidance.
• Identify potential quality concerns, flag high‑risk cases, and collaborate with quality assurance teams to conduct audits and corrective action plans.
• Participate in special projects, process improvement initiatives, and cross‑functional task forces as assigned, contributing innovative ideas that enhance member experience.

Essential Qualifications

• A Master’s degree in psychology, social work, counseling, or a closely related field.
• Minimum of four (4) years of direct experience providing ABA or mental health services, including clinical review, treatment plan oversight, and member advocacy.
• Current, unrestricted California licensure (LCSW, LPCC, LMFT, RN with behavioral health experience, BCBA, or BCBA‑D).
• Demonstrated ability to interpret and apply medical necessity criteria, coding guidelines, and coverage policies with precision.
• Proficiency in Microsoft Office Suite (Word, Outlook, Excel, PowerPoint) and familiarity with electronic health record (EHR) or utilization management platforms.
• Exceptional written and verbal communication skills, with a talent for translating complex clinical information into understandable language for members and providers.
• Strong analytical, problem‑solving, and project management capabilities, enabling you to prioritize tasks in a fast‑paced, remote environment.
• Self‑directed work ethic, coupled with the ability to collaborate effectively across virtual teams and diverse stakeholder groups.

Preferred Qualifications

• Additional certification in ABA (e.g., BCBA‑D) or a related specialty.
• Experience with remote case management platforms, telehealth tools, or digital health solutions.
• Knowledge of federal and state Medicaid regulations, especially as they pertain to BHT and ABA services.
• Prior experience in a fully remote or distributed workforce, demonstrating strong time‑management and virtual collaboration skills.
• Fluency in a second language, enhancing the ability to serve diverse member populations.

Core Skills & Competencies

• Member‑Centric Communication: Ability to listen actively, convey empathy, and provide clear guidance that builds trust.
• Regulatory Acumen: Deep understanding of HIPAA, state Medicaid rules, and ABA‑specific compliance requirements.
• Detail‑Oriented Documentation: Precision in recording case details, authorizations, and follow‑up actions within careerzynith’s systems.
• Collaborative Problem Solving: Working with clinicians, providers, and internal partners to resolve complex cases efficiently.
• Technology Fluency: Comfort navigating web‑based portals, data dashboards, and virtual communication tools (e.g., Zoom, Teams).
• Adaptability & Resilience: Ability to thrive in a dynamic environment, manage shifting priorities, and meet deadlines.
• Leadership Influence: Inspiring peers and external committees through positive attitude, mentorship, and proactive engagement.

Career Growth & Development

careerzynith invests heavily in the professional development of its employees. As a Remote Care Representative, you will have access to a robust learning ecosystem that includes:

• Structured onboarding and mentorship programs that pair you with seasoned clinical leaders.
• Continuing education stipends for certifications, conferences, and advanced training in ABA, behavioral health policy, or health informatics.
• Clear career pathways leading to senior case management, clinical supervision, quality assurance, or product development roles within careerzynith.
• Opportunities to participate in cross‑functional innovation labs, where you can help shape new digital tools and member services.
• Regular performance reviews that focus on skill expansion, goal setting, and alignment with your long‑term aspirations.

Work Environment & Culture at careerzynith

Our remote workforce is built on a foundation of trust, flexibility, and community. careerzynith promotes:

• Flexibility: Choose a schedule that aligns with your personal commitments while meeting core business hours.
• Inclusivity: A diverse, equity‑focused culture where every voice is heard and valued.
• Collaboration: Virtual “watercooler” spaces, regular team huddles, and interactive webinars that keep you connected.
• Well‑Being: Access to mental‑health resources, wellness stipends, and ergonomic support for home office setups.
• Recognition: Programs that celebrate individual achievements, team milestones, and innovative contributions.

Compensation, Benefits & Perks

careerzynith offers a competitive salary that reflects your experience and expertise, complemented by a comprehensive benefits package designed to support your health, financial security, and work‑life balance. While exact figures will be discussed during the interview process, you can expect:

• Medical, dental, and vision insurance with multiple plan options.
• Retirement savings plan featuring company matching contributions.
• Generous paid time off, vacation days, and paid holidays.
• Flexible spending accounts (FSAs) and health savings accounts (HSAs).
• Professional development allowance for certifications, courses, and conferences.
• Home office stipend to equip your workspace with ergonomic furniture and technology.
• Employee assistance program (EAP) offering counseling, legal, and financial guidance.
• Recognition awards, performance bonuses, and referral incentives.

How to Apply

If you are passionate about delivering compassionate, high‑quality care to members in need, and you thrive in a remote, collaborative environment, we want to hear from you. To join careerzynith’s mission‑driven team, please submit your resume and a cover letter that highlights your relevant experience, your commitment to behavioral health, and why you believe you would excel as a Remote Care Representative. Our recruiting team reviews applications on a rolling basis, and qualified candidates will be contacted promptly for the next steps.

Take the Next Step

At careerzynith, every interaction matters, and every team member plays a pivotal role in shaping the future of behavioral health services. By joining us, you will not only advance your career but also help thousands of members achieve better health outcomes. Apply today and become part of a forward‑thinking organization that values your expertise, your compassion, and your drive to make a difference.

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