Clinical Care Coordinator - Remote Mountain Time Zone
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Doing the right thing is a way of life at Rocky Mountain Health Plans (RMHP). As part of the United Healthcare family of plans, RMHP provides innovative health insurance coverage and personalized attention to individuals of all ages and business of all sizes throughout Western and rural Colorado. RMHP is continually striving to improve the health and wellness of our members and partners in the state where we live, work, and play - because we're Colorado, too.
As part of a utilization management team who will manage complex members, the Utilization Management Clinical Coordinator, Substance Use and Behavioral Health will be the primary care manager for a panel of members with complex behavioral health and substance use disorders.. Care coordination activities will focus on supporting member's medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care.
If you are a Licensed Addictions Counselor (LAC) or LPC, LMFT or LCSW with Colorado licensing, you will have the flexibility to work remotely
Β as you take on some tough challenges. Schedule is Monday through Friday 9:30am - 6:00pm Mountain Time. There will be some weekend/holiday coverage required based on business needs.
Primary Responsibilities:
Β Provide consultation to providers and/or consumers on a variety of issues including benefit information, safety issues, confirmation of prior authorizations and approvals, procedures for higher levels of care evaluations, and request for an explanation of the level of care, coverage determination, or best practice guidelines
Β Respect confidentiality and maintain confidences as described in the UHG Employee Handbook and acknowledged through signature by all employees. The ability to maintain confidentiality is a critical and essential component of this position
Β Support outcome focused, evidence-based best practices and guidelines with providers
Β Establish and maintain professional working relations with referral sources, community resources, and care providers and be able to identify and communicate network gaps
Β Appropriately identify the need for higher level reviews such as staffing, peer review, or MD consultation. Formulate concise case overviews
Β Provide management of behavioral health services, including crisis assessment and intervention
Β Process pre-authorization and notification of inpatient and other treatment services
Β Oversee initial inpatient admission for psychiatric and chemical dependency patients and provide concurrent review of inpatient and other treatment services
Β Conduct patient assessments and determine appropriate levels of care
Β Administer benefits, review treatment plans, and coordinate transitions between various areas of care
Β Obtain information from providers on outpatient requests for treatment
Β Work with consumers and providers to identify and help fill gaps in care and to help consumers move through the continuum of care as appropriate
Β Handle escalated calls and resolve complex issues. Ensure issues or changes are communicated and integrated as appropriate
Β Utilize individual thought to organize and validate data and develop reports s (e.g., production reports, utilization reports, compliance reports for internal and external audits, and validation of bed days per thousand)
Β Utilize clinical knowledge and critical thinking to apply evidence-based guidelines to clinical scenarios to determine medical appropriateness and appropriate level of care
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Β Meet one of the following:
Current, unrestricted independent licensure as a Licensed Addictions Counselor (LAC) in Colorado or LPC, LMFT or LSCW in Colorado with psychiatric and substance use treatment experience or behavioral health
Β 4+ years directly serving individuals with behavioral health conditions (mental health / substance use disorders)
Β 1+ years of experience with local behavioral health providers and community support organizations addressing SDoH (e.g., food banks, non-emergent transportation, utility assistance, housing / rapid re-housing assistance, etc.)
Β 1+ years of experience with MS Office, including Word, Excel, and Outlook
Β Must be able to work a schedule of Monday through Friday 9:30am - 6:00pm Mountain Time Zone.
Preferred Qualifications:
Β 1+ years of utilization management experience
Β Experience in serving individuals with co-occurring disorders (bothΒ
Apply Now
Doing the right thing is a way of life at Rocky Mountain Health Plans (RMHP). As part of the United Healthcare family of plans, RMHP provides innovative health insurance coverage and personalized attention to individuals of all ages and business of all sizes throughout Western and rural Colorado. RMHP is continually striving to improve the health and wellness of our members and partners in the state where we live, work, and play - because we're Colorado, too.
As part of a utilization management team who will manage complex members, the Utilization Management Clinical Coordinator, Substance Use and Behavioral Health will be the primary care manager for a panel of members with complex behavioral health and substance use disorders.. Care coordination activities will focus on supporting member's medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care.
If you are a Licensed Addictions Counselor (LAC) or LPC, LMFT or LCSW with Colorado licensing, you will have the flexibility to work remotely
Β as you take on some tough challenges. Schedule is Monday through Friday 9:30am - 6:00pm Mountain Time. There will be some weekend/holiday coverage required based on business needs.
Primary Responsibilities:
Β Provide consultation to providers and/or consumers on a variety of issues including benefit information, safety issues, confirmation of prior authorizations and approvals, procedures for higher levels of care evaluations, and request for an explanation of the level of care, coverage determination, or best practice guidelines
Β Respect confidentiality and maintain confidences as described in the UHG Employee Handbook and acknowledged through signature by all employees. The ability to maintain confidentiality is a critical and essential component of this position
Β Support outcome focused, evidence-based best practices and guidelines with providers
Β Establish and maintain professional working relations with referral sources, community resources, and care providers and be able to identify and communicate network gaps
Β Appropriately identify the need for higher level reviews such as staffing, peer review, or MD consultation. Formulate concise case overviews
Β Provide management of behavioral health services, including crisis assessment and intervention
Β Process pre-authorization and notification of inpatient and other treatment services
Β Oversee initial inpatient admission for psychiatric and chemical dependency patients and provide concurrent review of inpatient and other treatment services
Β Conduct patient assessments and determine appropriate levels of care
Β Administer benefits, review treatment plans, and coordinate transitions between various areas of care
Β Obtain information from providers on outpatient requests for treatment
Β Work with consumers and providers to identify and help fill gaps in care and to help consumers move through the continuum of care as appropriate
Β Handle escalated calls and resolve complex issues. Ensure issues or changes are communicated and integrated as appropriate
Β Utilize individual thought to organize and validate data and develop reports s (e.g., production reports, utilization reports, compliance reports for internal and external audits, and validation of bed days per thousand)
Β Utilize clinical knowledge and critical thinking to apply evidence-based guidelines to clinical scenarios to determine medical appropriateness and appropriate level of care
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Β Meet one of the following:
Current, unrestricted independent licensure as a Licensed Addictions Counselor (LAC) in Colorado or LPC, LMFT or LSCW in Colorado with psychiatric and substance use treatment experience or behavioral health
Β 4+ years directly serving individuals with behavioral health conditions (mental health / substance use disorders)
Β 1+ years of experience with local behavioral health providers and community support organizations addressing SDoH (e.g., food banks, non-emergent transportation, utility assistance, housing / rapid re-housing assistance, etc.)
Β 1+ years of experience with MS Office, including Word, Excel, and Outlook
Β Must be able to work a schedule of Monday through Friday 9:30am - 6:00pm Mountain Time Zone.
Preferred Qualifications:
Β 1+ years of utilization management experience
Β Experience in serving individuals with co-occurring disorders (bothΒ
Apply Now