Care Coordinator I, Behavioral Health (Utilization Management)

Job Summary Ensures quality care by reviewing patient assessments, care, and interventions for completeness and accuracy, prioritizing the patient experience during care transitions, documenting treatment plan progress, supporting the team by contributing updates in multidisciplinary clinical meetings, and assisting in the coordination of care needs (e.g., coordinating transfers, planning discharges, making community service referrals, reviewing and/or obtaining authorizations) across the continuum of care. Coordinates patient care by collaborating with treating clinicians to review and improve treatment plans, identifies and implements potential recommendations to enhance care coordination, makes referral recommendations, follows case management policies, and documents issues related to treatment plans and follow‑up appointments. Ensures compliance with policies to promote patient care and avoid liability, follows standards and regulations in interactions with patients, physicians, contact providers, medical staff, and outside agencies and supports efforts to maintain survey readiness and regulatory compliance in contracted facilities and/or medical centers. Collaborates with stakeholders to facilitate care by building relationships with external providers and medical staff, solving patient treatment issues, ensuring contract compliance, and serving as a liaison on contracting and referral processes. Manages patient data and records by compiling and reporting information (e.g., length of stay, services provided, cost), facilitating interventions, and conducting quality management studies and/or audits. Essential Responsibilities Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome. Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team. Ensures quality of care by: ensuring patient assessments, care, and interventions are comprehensive and accurate; advocating for patients during internal and external care transitions to ensure a smooth experience and escalating concerns; documenting the progression of treatment plans and conducting standard chart reviews; contributing updates during multi-disciplinary clinical consultation meetings to discuss patient treatment; and facilitating the team in coordinating with patient and/or care team (e.g., coordinating transfers, planning discharges, making community service referrals, reviewing and/or obtaining authorizations) to ensure patients move across the continuum of care. Manages patient data and records by: compiling and reporting patient information and data (e.g., length of stay, services provided, cost) and identifying opportunities for interventions as necessary; and conducting quality management studies and/or audits through data collection, data input, and report development. Coordinates the care of a moderate caseload of patients by: collaborating with the clinical team to disseminate treatment plans to patients and providers; identifying and implementing potential recommendations to improve care coordination; applying knowledge of guidelines and protocols to recommend patient referrals; following case management policies and procedures and suggesting improvements to promote member utilization and engagement of services; and documenting patient treatment plans and follow‑up appointments. Ensures member compliance with policies and procedures by: reporting all compliance failures which may lead to liability and follows up with leadership as necessary; following local, state, and federal standards, regulations, credentialing organizations requirements, health plan benefits, policies, and procedures when working with patients, physicians, medical office staff, contact providers, and outside agencies; and completing tasks related to the survey readiness program at contracted facilities and/or medical centers to maintain compliance with regulatory standards. Collaborates with stakeholders to facilitate care by: developing and maintaining relationships with all external stakeholders including providers, medical center physicians, and/or other staff to identify and solve problems related to patient treatment and ensure contract compliance; and serving as a liaison with outside contractors for contracting consultation including informing and advising on the organizations levels of care and referral process. Minimum Qualifications Minimum two (2) years of experience in behavioral health case management or care coordination. Masters degree in Psychology, Counseling, Social Work, or a related field AND minimum three (3) years of experience in counseling, social work, or a directly related field. This job requires credentials from multiple states. Credentials from the primary work state are required at hire. Additional Credentials from the secondary work state(s) are required post hire. Licensed Clinical Social Worker (Oregon) within 6 months of hire AND Licensed Independent Clinical Social Worker (Washington) within 6 months of hire Mental Health Counselor License (Washington) within 6 months of hire AND Professional Counselor License (Oregon) within 6 months of hire Licensed Marriage and Family Therapist (Oregon) within 6 months of hire AND Licensed Marriage and Family Therapist (Washington) within 6 months of hire Psychologist License (Oregon) within 6 months of hire AND Psychologist License (Washington) within 6 months of hire National Provider Identifier required at hire #J-18808-Ljbffr Socket.dev