Behavioral Health Utilization Management Care Coordinator

About This Role

The Behavioral Health Utilization Management Care Coordinator reviews clinical information to ensure it meets medical necessity criteria for authorizing services. This role assesses managed care contracting, CMHRS, BH, ARTS services, and DMAS protocols to ensure compliance and accurate claims processing.

Responsibilities

• Review clinical information received from providers to ensure clinical data meets Medical Necessity Criteria
• Authorize services as needed based on clinical data review
• Ensure knowledge of managed care contracting, Medical Necessity, CMHRS services, BH and ARTS services, DMAS protocols, clinical protocols and clinical review requirements
• Maintain 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 of payment

Requirements

• Master’s degree in Counseling, Social Work, or Marriage and Family Therapy OR BSN for Registered Nurses
• Valid state license (LCSW, LPC, LMFT, or RN) in VA or NC
• 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
• Knowledge of 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 or Bachelor of Science in nursing
• 2 years of behavioral health experience and 1 year of case management experience

Nice to Have

• Experience in a residential facility/residence

Benefits