We are currently seeking a dynamic Value Recovery Coordinator – Care Manager ICM to join our team at our office in Oil City or Meadville, PA! The Value Recovery Coordinator – Care Manager ICM will conduct telephone assessments, collecting sufficient data to make appropriate referral and authorization decision for emergency, urgent, and routine levels of care. Makes appropriate utilization management decisions. Collaborates with providers to determine alternate levels of care and to facilitate transfers to network facilities and providers whenever possible. Facilitates coordination of care with other service managers and aftercare coordinators to assure continuity of care. Evaluates clinical appropriateness of treatment using professional knowledge within VBH-PA medical necessity guidelines and renders authorization decisions or seeks peer advisor consultations for non-authorization decisions.
***Prefer a candidate that lives in the Oil City or Meadville, PA area.
- Completes telephone assessments and referrals; gathers demographic and clinical information to connect member with appropriate provider, including outpatient treatment as necessary; and for emergency, urgent, and routine referrals
- Reviews for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply VBH-PA criteria and renders authorization decisions
- Coordinates with other Care Managers to assure those members’ comprehensive treatment needs are met
- Applies utilization management policies and procedures for determination of initial, concurrent and retrospective review
- Refers cases that do not meet criteria and need non-authorization decision to Peer Advisor
- Utilizes rounds and case consultations to Clinical Supervisor and Peer Advisor for quality of care cases
- Ensures continuity of patient care through contact with providers and assigned individuals
- Clinical documentation to reflect recovery principles, active and longitudinal care management interventions and quality of care issues.
- Completes monthly referral registrations to meet quantitative and qualitative standards
- Participates in customer service assessment activities, including telephone and medical record audits.
- 10% travel required to meet with our members in an inpatient acute mental health setting in Crawford, Mercer, and Venango counties.
Master’s Degree in a mental health related field required (or Associates Degree with RN license)
This position requires licensure in a mental health related field (RN, Ph.D., LPC, LCSW/ACSW, etc.)
Relevant Work Experience:
Minimum of 3 years of experience in psychiatric and substance abuse treatment. Experience in settings that include inpatient, partial, and/or outpatient care preferred
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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled
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