Patient Care Coordinator

1 week ago


Pittsfield, Massachusetts, United States LanceSoft, Inc. Full time

Position: Care Manager

Work Arrangement: Remote

Working Hours: Day Shift (8:00am - 5:00pm) Central Time

Contract Length: 3 Months (with potential for extension)

Weekly Commitment: 40 hours

Key Responsibilities

  • Oversees inpatient and outpatient care services associated with mental health and substance use treatment to ensure medical necessity and effectiveness.
  • Conducts telephone triage, crisis intervention, and emergency authorizations as needed.
  • Executes concurrent reviews for inpatient and outpatient care and other service levels within the scope of practice and expertise.
  • Collaborates with healthcare providers and facilities to formulate and implement discharge plans.
  • Conducts quality clinical assessments while educating and making necessary interventions to enhance patient care.
  • Informs members and providers about mental health and substance use benefits, community treatment options, managed care programs, and organizational policies and procedures.
  • Engages with Physician Advisors to address clinical and authorization inquiries regarding specific cases.
  • Participates in quality improvement initiatives, including data collection, monitoring, and analysis.
  • Maintains an active caseload in alignment with National Care Manager performance benchmarks.
  • Collaborates with community organizations as appropriate.
  • Suggests alternative treatment plans when service requests do not fulfill medical necessity criteria.
  • Contributes to network development by identifying and recruiting quality providers as necessary.
  • Advocates for patients to ensure their treatment needs are adequately addressed.
  • Interacts with providers in a professional and respectful manner that supports the treatment process.

Qualifications

  • Minimum of 2 years of clinical experience.
  • CERTIFICATIONS: Must possess one of the following: CEAP - Certified Employee Assistance Professional, LCSW - Licensed Clinical Social Worker, LMFT - Licensed Marriage and Family Therapist, LMSW - Licensed Master Social Worker, LPC - Licensed Professional Counselor, LPN - Licensed Practical Nurse, RN - Registered Nurse, State and/or Compact State Licensure.

Educational Requirements:

  • Dependent on Certification: Associate's in Nursing, Bachelor's in Social Work, Master's in Social Work (Required).


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