Job Description

The Behavioral Health (BH) Care Management Coordinator primary responsibility is to evaluate a member's Behavioral health conditions through the review of medical records (including medical history and treatment records) to determine the medical necessity for patient's services based on advanced knowledge and independent analysis of those medical records and application of appropriate medical necessity criteria. The BH Care Management Coordinator will also directly interact with providers to obtain additional BH information as well as authorize services determined to be medically necessary based on their personal review. For those cases that do not meet established criteria, the BH Care Management Coordinator provides relevant information regarding members BH condition to the Medical Director for their further review and evaluation. The BH Care Management Coordinator has the authority to approve but cannot deny the care for patients. The BH Care Management Coordinator is also responsible for maintaining regulatory compliance with federal, state and accreditation regulations. Additionally, the BH Care Management Coordinator acts a patient advocate and a resource for members when accessing and navigating the behavioral health care system.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com .

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Skills and Requirements

MUST BE LOCAL TO PA AND BE OK WITH WORKING 100% REMOTE

-MUST HAVE AN ACTIVE : LCSW or LMFT or LPC or RN/BSN in PA

-Knowledge of InterQual, American Society of Addiction Medicine criteria (ASAM), Care Management Policy, Medical Policy and Electronic Desk References to determine the medical appropriateness of the proposed plan.

-Utilizes the behavioral health criteria of InterQual, ASAM and/or Medical Policy to establish the need for inpatient, continued stay and length of stay, procedures and ancillary services.

-Reviews treatment plans/plan of care with providers for requested services/procedures, inpatient admissions or continued stay, clarifying behavioral health information with provider if needed.

-Knowledge of state, federal and accreditation regulations null

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to HR@insightglobal.com.