Overview

Behavioral Health Utilization Management Care Coord is responsible for review of clinical information received from providers ensuring clinical data is substantial enough to meet Medical Necessity Criteria to authorize services as needed. Requires knowledge of managed care contracting, Medical Necessity, CMHRS services, BH and ARTS services, DMAS protocols, clinical protocols and clinical review requirements. Requires knowledge of contractual, regulatory and compliance requirements for government payers, self funded and commercial payers. Ensures appropriate and accurate information is entered into claims system for processing of payment.<br /><br />Qualifications<br /><br /><strong>Education Level</strong><br />Master's Level Degree – COUNSELING OR<br />Master's Level Degree – SOCIAL WORK OR<br />RN-Bachelor's Level Degree<br /><br /><strong>Experience</strong><br />Required: Clinical – 2 years<br /><br />Preferred: Case Management – 1 year<br /><br /><strong>License</strong><br />Required: License Clinical Social Worker, License Professional Counselor, Registered Nurse<br /><br />Preferred: None, unless noted in the "Other" section below<br /><br /><strong>Skills</strong><br />Required: <br /><br />Preferred: None, unless noted in the "Other" section below<br /><br /><strong>Other</strong><br />2 years experience working in behavioral health and 1 years' experience with behavioral health care coordination, discharge planning, continuity of care or transitions of care required. LCSW or LPC or LMFT or RN current license for the state of Virginia. LMHP- S, LMHP-R may be considered if actively working towards licensure and prior experience is present


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