Behavioral Health Care Management Coordinator

Location:
Remote (must reside in PA, NJ, or DE)

Overview
The Behavioral Health (BH) Care Management Coordinator plays a key role in ensuring members receive appropriate, high-quality behavioral health care. This position is responsible for evaluating behavioral health conditions, reviewing medical records, and determining the medical necessity of services using evidence-based criteria. The Coordinator applies advanced clinical knowledge and independent judgment to support care decisions, promote efficient utilization, and ensure regulatory compliance.

This is a remote position; however, candidates must reside in the tri-state area (PA, NJ, or DE).

Qualified applicants must hold an active RN, LSW, LCSW, LPC, or LMFT license.

Key Responsibilities

• Evaluate members' behavioral health conditions by reviewing medical and treatment records to determine medical necessity.
• Apply critical thinking and independent clinical judgment using InterQual, ASAM, and internal medical policies to assess the appropriateness of services and length of stay.
• Collaborate with servicing providers to clarify treatment plans, care needs, and medical necessity for behavioral health services.
• Independently authorize services determined to be medically necessary; escalate cases not meeting criteria to the Medical Director for further review.
• Identify discharge planning needs early and collaborate with case management staff or physicians to ensure safe and appropriate transitions of care.
• Report utilization patterns or potential issues to management and recommend process improvements.
• Refer cases appropriately to Quality Management, Case Management, or Disease Management teams as indicated.
• Ensure requests comply with member benefits, regulatory standards, and accreditation requirements.
• Maintain accurate, timely documentation of all utilization review activities and decisions.
• Meet or exceed departmental productivity and turnaround time goals.
• Maintain data integrity in all systems and uphold confidentiality and compliance standards.

Qualifications
Education & Licensure

• Active PA RN license (BSN preferred) OR current licensure as an LCSW, LMFT, LPC, or LSW in good standing.

Experience

• Minimum 3 years of behavioral health clinical experience in a hospital or healthcare setting required.
• Behavioral Health utilization management or precertification experience strongly preferred.
• Experience in case management, discharge planning, or medical management is a plus.

Knowledge, Skills & Abilities

• Strong understanding of behavioral health and substance use disorder criteria, including InterQual and ASAM.
• Excellent critical thinking, problem-solving, and decision-making abilities.
• Exceptional written and verbal communication skills with providers, members, and team members.
• Organized and detail-oriented with strong time management skills.
• Collaborative team player who builds rapport and fosters a positive work environment.
• Flexible and adaptable to changing workflows, policies, and technologies.
• Proficient in Microsoft Word, Outlook, Excel, SharePoint, and Adobe applications; ability to learn new systems quickly.
• Demonstrates professionalism, accountability, and a commitment to patient advocacy.

About The Role
This position offers an opportunity to apply your clinical expertise in a non-direct care setting while helping ensure that members receive the most appropriate behavioral health services. The Behavioral Health Care Management Coordinator acts as both a clinical reviewer and a patient advocate — promoting quality, cost-effective care while maintaining compliance with all state, federal, and accreditation standards.