Licensed Behavioral Health Care Coordinator I (LCSW, LPC, LMFT)

About the role

This is a FT WFH role.

Responsibilities

• Promotes positive treatment outcomes by helping members identify clinically appropriate services and making referrals for Behavioral Health Case Management.
• Affords assistance to members in navigating treatment options, understanding the authorization process, and accessing services.
• Evaluates treatment services for medical necessity and appropriate type of treatment and level of care.
• Provides courteous and accurate customer service to members, family members and care providers.
• Participates in researching articles outlining evidence-based practices for behavioral health treatment and participates in revising and developing Moda Behavioral Health medical necessity criteria.
• Participates in Inter-Rater Reliability exercises with clinical team.
• Provides clinical consultation to Health Coaches and Nurses within Healthcare Services.
• Tracks and reports cost-savings obtained through medical necessity denials, negotiated discounts, reduced levels of care and lengths of stay.
• Completes Continuity of Care, Transition of Care, and Single Case Agreements.
• Negotiates pricing for Single Case Agreements with out-of-network facilities and providers when approved by the Moda Health Medical Director and allowed by member’s plan
• Prepares cases in a clear and concise manner for Moda Health Medical Director review.
• Writes clear, individualized denial letters that reference specific criteria or handbook language.
• Completes provider searches for members, family members and Moda Healthcare Service teams.
• Understands and follows Moda authorization and utilization review processes.
• Ensures authorization determinations meet timeliness standards and are completed promptly and accurately.
• Communicates clearly and assertively with providers and develops and maintains positive relationships with them.
• Completes documentation of contact with members and providers in a thorough, accurate and professional manner.
• Reports suspected fraud, waste, and abuse to Moda Health Special Investigation Unit.
• Uses Moda systems (Benefit Tracker, Care Web, Content Manager, Facets) to give accurate information to members and providers.
• Solves member and provider concerns before they become grievances/complaints, whenever possible.
• Works in a collaborative manner with providers and other Moda employees.
• Responds to occasional crisis calls from members. Assesses for safety, develops safety plans if needed, and provides treatment options.

Qualifications

• Active Oregon license as a behavioral health practitioner.
• At least three years recent experience in behavioral health (mental health and/or chemical dependency) clinical settings.
• Excellent communication skills, both written and verbal, including ability to de-escalate and calm upset or distressed individuals.
• Excellent analytic, problem solving, and personal time/task management skills.
• Excellent memory retention and attention to detail.
• Demonstrated ability to work well under pressure.
• Ability to present oneself in a professional manner telephonically and in person.
• Demonstrated ability to work across multiple computer applications.
• Type a minimum of 35 wpm on a computer keyboard.
• Ability to come in to work on time and daily.
• Maintain confidentiality and protect the privacy of member information.

Skills

• Knowledge of resources and coverage.

Benefits

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Pay

$71,990.85 - $89,988.57 annually. This role may be classified as hourly (non-exempt) depending on the applicant's location. Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Schedule

FT WFH