Behavioral Health Coordinator

Behavioral Health Coordinator needed for a contract opportunity with Yoh's insurance client located in Philadelphia, PA . This position is remote but candidates will need to reside in tri-state area (PA, NJ, DE). The Behavioral Health (BH) Care Management Coordinator primary responsibility is to evaluate a member's BH condition through the review of medical records to determine the medical necessity for patient's services. The BH Care Management Coordinator acts a patient advocate and a resource for members when accessing and navigating the behavioral health care system.

This position is remote, but candidates will need to reside in tri-state area (PA, NJ, DE)

Schedule : Monday-Friday 8am-5pm

Duration : 11 / 24-2 / 24 with possibility to extend

Pay : $34-41 / hr

What You'll Be Doing :

• Applies critical thinking and judgement skills based on advanced medical knowledge to cases utilizing specified resources and guidelines to make case determination. Utilizes resources such as; 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.
• Contacts servicing providers regarding treatment plans / plan of care and clarifies medical need for 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.

What You Need to Bring to the Table :

What's In It For You?

APPLY NOW!

Recruiter

Laura Mopas

Estimated Min Rate

$34.00

Estimated Max Rate

$41.00

What's In It for You?

We welcome you to be a part of the largest and legendary global staffing companies to meet your career aspirations. Yoh's network of client companies has been employing professionals like you for over 65 years in the U.S., UK and Canada. Join Yoh's extensive talent community that will provide you with access to Yoh's vast network of opportunities and gain access to this exclusive opportunity available to you. Benefit eligibility is in accordance with applicable laws and client requirements. Benefits include :

Note : Any pay ranges displayed are estimations. Actual pay is determined by an applicant's experience, technical expertise, and other qualifications as listed in the job description. All qualified applicants are welcome to apply.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Visit https : / / www.yoh.com / applicants-with-disabilities to contact us if you are an individual with a disability and require accommodation in the application process.

For California applicants, qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All of the material job duties described in this posting are job duties for which a criminal history may have a direct, adverse, and negative relationship potentially resulting in the withdrawal of a conditional offer of employment.

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