Behavioral Health Utilization Management Care Coordinator applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health outpatient and/or inpatient services, Mental Health Services (MHS), and/or Addiction Recovery and Treatment Services (ARTS). Responsible for reviewing clinical information received from providers ensuring clinical data is substantial enough to meet Medical Necessity Criteria to authorize services as needed. Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, applying evidence-based standards, and practice guidelines to treatment where appropriate. Requires knowledge of managed care contracting, medical necessity, and Medicaid and Medicare behavioral health and substance use services. Knowledge of DMAS protocols, NCQA, CMS, clinical protocols and clinical review requirements.  

Education

• Bachelor of Science in Nursing, Masters of Counseling, OR Masters of Social Work Required

Certification/Licensure

• LCSW or LPC or LMFT or RN current license for the state of Virginia

Experience

• 2 years of experience working in behavioral health Required

• 1 year of experience with behavioral health care coordination, discharge planning, continuity of care or transitions of care Required