Behavioral Health Care Management Coordinator - Remote | WFH

Key Responsibilities

As a Behavioral Health Utilization Management Specialist, you'll apply advanced medical knowledge and critical thinking to assess cases, utilizing various resources and guidelines to make informed determinations. This includes utilizing tools such as InterQual, American Society of Addiction Medicine criteria (ASAM), and relevant policy references to evaluate the medical appropriateness of proposed plans.

Utilize InterQual and ASAM criteria to determine the need for inpatient care, continued stay, and appropriate length of stay, as well as procedures and ancillary services.

Collaborate with service providers to clarify treatment plans and establish the medical necessity of services.

Review treatment plans with providers, addressing any behavioral health considerations as necessary.

Identify cases not meeting established criteria and refer them to the Medical Director for further evaluation.

Proactively identify members for discharge planning evaluation and collaborate on finding suitable alternative settings when needed.

Report utilization trends and potential issues to designated managers, along with recommendations for improvement.

Ensure compliance with state, federal, and accreditation regulations in all utilization decisions.

Meet or exceed regulatory turnaround time and productivity goals for processing referral and authorization requests.

Maintain thorough documentation of all key functions in accordance with Care Management Coordination Policy.

Ensure integrity of system information through timely and accurate data entry.

Perform any additional duties as assigned.

Qualifications

Education:

LCSW or LMFT or LPC or Active PA Licensed RN, BSN Preferred

Experience

Minimum of three (3) years of Behavioral Health clinical experience in a hospital or other healthcare setting.

Prior Behavioral Health utilization management experience is desirable.

Medical Management/precertification Experience Preferred.

Knowledge & Skills:

Exceptional communication, problem-solving, and interpersonal skills.

Action-oriented with a strong ability to set priorities and achieve results.

Team player who fosters team spirit and interdepartmental rapport.

Open to change, adaptable, and comfortable with new ideas and methods.

Respectful of diversity and colleagues, internally and externally.

Excellent organizational, planning, and prioritizing skills.

Proficient in Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs.

Ability to adapt to new systems and technologies as needed.

This position offers an exciting opportunity to make meaningful contributions in behavioral health care management while working within a collaborative and supportive team environment. If you're passionate about utilizing your clinical expertise to drive positive outcomes for patients, we encourage you to apply.

Employment Type: Full-Time