Behavioral Health Utilization Management Care Coordinator

About This Role

This role involves reviewing clinical information from providers to ensure services meet Medical Necessity Criteria for authorization. It focuses on Behavioral Health Utilization Management and Care Coordination for residential facilities within a hybrid work arrangement.

Responsibilities

• Review clinical information received from providers
• Ensure clinical data meets Medical Necessity Criteria to authorize services
• Utilize knowledge of managed care contracting, Medical Necessity, CMHRS services, BH and ARTS services, DMAS protocols, clinical protocols, and clinical review requirements
• Apply knowledge of contractual, regulatory, and compliance requirements for government, self-funded, and commercial payers
• Ensure appropriate and accurate information is entered into the claims system for processing payment

Requirements

• Master's degree in Counseling, Social Work, or Marriage and Family Therapy (or BSN for RNs)
• Valid state license as LCSW, LPC, LMFT, or RN in Virginia or North Carolina
• 2 years of behavioral health experience
• 1 year of case management experience
• Knowledge of managed care contracting, Medical Necessity, CMHRS services, BH and ARTS services, DMAS protocols, clinical protocols, and clinical review requirements
• Knowledge of contractual, regulatory, and compliance requirements for government, self-funded, and commercial payers

Qualifications

• Master’s degree in Counseling, Social Work, or Marriage and Family Therapy required. For Registered Nurses, a Bachelor of Science in nursing is required.
• 2 years of behavioral health experience and 1 year of case management experience.

Nice to Have

• Experience in a residential facility

Benefits