Category: Healthcare

Employment Type: Contract

Reference: BH-372762

Behavioral Health Care Management Coordinator-remote needed for a contract opportunity with Yoh's client located in Philadelphia, PA

Top Skills You Should Possess:

• LCSW or LMFT or LPC or Active PA Licensed RN, BSN Preferred
• Position will be remote but will need to reside in tri-state area (PA, NJ, DE).
• Will need your own computer

• The Behavioral Health (BH) Care Management Coordinator primary responsibility is to evaluate a member's BH condition through the review of medical records (including medical history and treatment records) to determine the medical necessity for patient's services

• Reviews treatment plans/plan of care with provider for requested services/procedures, inpatient admissions or continued stay, clarifying behavioral health information with provider if needed.
• Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Director for further evaluation determination.
• Performs early identification of members to evaluate discharge planning needs.
• Collaborates with case management staff or physician to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting.
• Reports potential utilization issues or trends to designated manager and recommendations for improvement.
• Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Manager when indicated to include delays in care.
• Appropriately refers cases to Case and Disease Management.
• Ensures request is covered within the member's benefit plan.
• Ensures utilization decisions are compliant with state, federal and accreditation regulations.
• Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests.
• Ensures that all key functions are documented in accordance with Care Management Coordination Policy.
• Maintains the integrity of the system information by timely, accurate data entry.
• Performs additional duties assigned.

• (3) years of Behavioral Health clinical experience in a hospital or other health care setting.
• Prior Behavioral Health utilization management experience is desirable
• LCSW or LMFT or LPC or Active PA Licensed RN, BSN Preferred

• Join Yoh's extensive talent community that will provide you with access to Yoh's vast network of opportunities.
• Weekends and holidays off
• Direct deposit & weekly epayroll