Position Summary
The
Behavioral Health Care Coordinator is responsible for the facilitation and coordination of inpatient and outpatient care through telephonic precertification, concurrent review and discharge coordination. Provides participants with provider referrals to obtain the most appropriate, cost efficient, high quality care. Provides case management to a small, select group of participants, acts as consultant/co-manager with RNs on medical cases with significant Behavioral Health issues.
Examples Of Duties
- Performs telephonic prospective, concurrent and retrospective evaluation of clinical information to establish medical necessity, appropriateness of services, and compliance with medical policy. Forwards all cases that require adverse determination of medical necessity to the Medical Director.
- Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines and accepted standards of care.
- Collaborates with other departments or payors to resolve claims adjudication, authorizations, and quality of care, and member or provider issues.
- Participates in clinical rounds, Quality Improvement projects and Medical Management programs as required.
- Identifies and initiates case management on specific selected members or participants utilizing the 6 essential case management activities or refers cases to the appropriate group Case Management.
- Interviews client and family and obtains consent for Level II case management services on identified members.
- Provides consistent and accurate documentation using FCH Applications.
- Creates member correspondence using plain language and ensuring compliance with internal policies and procedures.
- Frequently interacts with EAP and Medical Management staff, medical and allied health professionals to discuss coverage questions, treatment, discharge issues and resources available.
- Suggests and negotiates alternative solutions including appropriate levels of care delivery when indicated.
- Acts as a liaison to members, participants and providers of care.
- Identifies and reports all quality issues to appropriate staff.
- Completes month-end updates and case management notes for invoicing by the established date.
- Other duties as assigned.
Qualifications
- Current, unrestricted state license as a Mental Health Counselor, Marriage and Family Therapist, Social Worker, Psychologist or a related field.
- Masters Degree or higher required.
- Five (5) years minimum experience in clinical Mental Health with chemical dependency experience.
- Knowledge of principles of prospective, concurrent, and retrospective clinical review and continuous quality improvement preferred.
- Knowledge of health insurance industry standards preferred.
- Previous case management experience in an HMO or managed care environment preferred.
- CCM or related case management certification preferred..
- Demonstrates analytical ability to identify problems, develop solutions and implement a course of action within an acceptable interpretation of departmental policies and procedures.
- Professional demeanor, functions well in stressful situations, prioritizes with minimal direction.
- Excellent problem solving, negotiation and conflict resolution skills.
- Ability to demonstrate strong written, verbal and interpersonal communication skills with varying levels of internal and external agencies and medical professionals.
- Proficiency in PC Applications including Word, Excel and Outlook.
Physical Requirements
- Normal hand and finger dexterity
- Ability to stand or sit for long periods of time
- Ability to see and hear within normal ranges, with or without aid
Access To Personal Health Information (PHI)
This position has routine & re-occurring access to all forms of PHI – The duties of the position require regular and unrestricted contact with PHI.
Pay Range: $89,000-$93,000 annually
We are an Equal Opportunity Employer and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by applicable law.
Benefits
- Medical & Vision- We offer two medical plans for employees, High Deductible and PPO plan for employees to choose from.
- Dental- A dental plan through Sun Life dental is available to employees and eligible dependents.
- Health Savings Account (HSA)- Employees who enroll in our medical plan can choose to establish a health savings account if eligible. FCH makes contributions to the HSA and employees may contribute pre-tax dollars via payroll deduction up to the IRS allowable limits.
- Flexible Spending Account (FSA)- Employees may contribute pre-tax dollars through payroll deduction to a limited vision/dental FSA. Unlike with an HSA, unused FSA funds do not rollover from year to year.
- Life Insurance- FCH provides life insurance benefits at no cost at a limit of two times an employee's annual base salary (with a max of $300,000). Employees have the opportunity to purchase additional life insurance for themselves and their dependents through payroll deduction.
- Short & Long-Term Disability Insurance- FCH provides long-term and short-term disability coverage to all employees. It is a shared cost benefit where FCH pays for the long-term benefit and employees pay for the short-term benefit.
- Personal Leave and Sick Time- FCH employees enjoy the benefit of paid time off. Vacation, sick leave, and any personal leave are combined into a general annual PTO bank. PTO accruals are based on service on a pay period: 0-1 year of service - 120 hours; 1-2 years of service - 136 hours; 3+ years of service - 168 hours.
- Paid Holidays- Employees receive thirteen paid holidays and four four-hour time blocks for community service per year.
- Employee Assistance Program (EAP)- FCH recognizes that a variety of problems can disrupt personal and work life. If an employee needs professional help, they can contact the EAP, which provides confidential access to professional counseling services for help in confronting personal problems such as alcohol/substance abuse, marital and family difficulties, financial or legal troubles, or emotional distress.
- Retirement Plan 401(k)- We contribute 50% of the employee's 401k deferral, up to a maximum of 3% of the employee's gross salary. Eligible employees must be at least 21 years old, and be employed with FCH a minimum of 90 days.
- Profit Sharing - FCH may make annual discretionary profit sharing contributions in an amount to be determined at Plan Year end.
- Tuition Reimbursement - Employees may be eligible to receive reimbursement for continuing education for Bachelor's program after one year of employment with the company.
- Wellness- We encourage and promote healthy behaviors through a Wellness program that offers rewards for those that participate.
- These benefits may be changed with or without notice at any given time.
For California employees, please review Privacy Act: https://www.fchn.com/documents/fch/pdf/caprivacynoticeemployeesandapplicantsfinal8-23- 20231.pdf
