Behavioral Health Care Coordinator I ~ Active License Needed ~ Remote If You Live In Ak, Az, Fl, Id, Tx, Or, Wa

Job Title
Behavioral Health Care Coordinator I ~ active license needed ~ remote if you live in AK, AZ, FL, ID, TX, OR, WA
Duration
Open Until Filled
Work From Home
Yes
Work Remote
Yes
Description
Let’s do great things, together Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.Evaluates, authorizes, and manages behavioral health services to plan members.
Interacts with members, family, and care providers to coordinate quality care in clinically appropriate settings.
Applies clinical expertise with knowledge of resources and coverage, to promote effective, efficient treatment outcomes. This is a full-time remote position for candidates living or willing to relocate to the following States ONLY: AK, AZ, FL, ID, OR or WA.
Please follow the link below to apply to this position:

• Https://j.brt.mv/jb.do?reqGK=27706504&refresh=true

Benefits

• PTO and Company Paid Holidays
• Employee Assistance Program
• FSA
• 401K- Matching
• Medical, Dental, Vision, Pharmacy, Life, & Disability

Primary Functions Level I

• Tracks and reports cost-savings obtained through medical necessity denials, negotiated discounts, reduced levels of care and lengths of stay.
• Understands and follows Moda authorization and utilization review processes.
• Responds to occasional crisis calls from members.
• Assesses for safety, develops safety plans if needed, and provides treatment options.
• Provides courteous and accurate customer service to members, family members and care providers.
• Provides clinical consultation to Health Coaches and Nurses within Healthcare Services.
• Completes documentation of contact with members and providers in a thorough, accurate and professional manner.
• Resolves member and provider concerns before they become grievances/complaints, whenever possible.
• Participates in Inter-Rater Reliability exercises with clinical team.
• Completes Continuity of Care, Transition of Care, and Single Case Agreements.
• Negotiates pricing for Single Case Agreements with out-of-network facilities and providers when approved by the Moda Health Medical Director and allowed by member’s plan
• Writes clear, individualized denial letters that reference specific criteria or handbook language.
• Uses Moda systems (Benefit Tracker, Care Web, Content Manager, Facets) to give accurate information to members and providers.
• Communicates clearly and assertively with providers and develops and maintains positive relationships with them.
• Ensures authorization determinations meet timeliness standards and are completed promptly and accurately.
• Participates in researching articles outlining evidence-based practices for behavioral health treatment and participates in revising and developing Moda Behavioral Health medical necessity criteria.
• Prepares cases in a clear and concise manner for Moda Health Medical Director review.
• Perform other duties as assigned
• Works in a collaborative manner with providers and other Moda employees.
• Evaluates treatment services for medical necessity and appropriate type of treatment and level of care.
• Reports suspected fraud, waste, and abuse to Moda Health Special Investigation Unit.
• Assists members in navigating treatment options, understanding the authorization process, and accessing services.
• Promotes positive treatment outcomes by helping members identify clinically appropriate services and making referrals for Behavioral Health Case Management.
• Completes provider searches for members, family members and Moda Healthcare Service teams.

Required Skills Level I
+
Active Oregon license as a behavioral health practitioner.
+
At least three years recent experience in behavioral health (mental health and/or chemical dependency) clinical settings.

• Excellent analytic, problem solving, and personal time/task management skills.
• Excellent communication skills, both written and verbal, including ability to de-escalate and calm upset or distressed individuals.
• Ability to come in to work on time and daily.
• Demonstrated ability to work across multiple computer applications.
• Excellent memory retention and attention to detail.
• Type a minimum of 35 wpm on a computer keyboard.
• Ability to present oneself in a professional manner telephonically and in person.
• Demonstrated ability to work well under pressure.
• Maintain confidentiality and protect the privacy of member information.

Moda Health Seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our [email protected] email.
Pay Range
¤65,188.50
Annually to ¤74,807.98
Annually