Licensed Behavioral Health Care Coordinator I (LCSW, LPC, LMFT)

Evaluate, authorize, and manage behavioral health services to plan members while interacting with families and care providers to coordinate quality care. Apply clinical expertise to promote effective treatment outcomes by identifying clinically appropriate services and making referrals for Behavioral Health Case Management. Assist members in navigating treatment options and understanding the authorization process, then evaluate services for medical necessity and appropriate level of care. Provide courteous customer service to members and providers, complete documentation of contacts, and resolve concerns before they become grievances. Participate in researching evidence-based practices, revising medical necessity criteria, and conducting Inter-Rater Reliability exercises with the clinical team. Prepare cases for Medical Director review, negotiate pricing for Single Case Agreements, and write clear denial letters referencing specific criteria. Track cost-savings from denials and discounts, complete continuity and transition of care agreements, and report suspected fraud to the Special Investigation Unit. Use Moda systems to provide accurate information and respond to occasional crisis calls by assessing safety and developing treatment options.