Job Details

Provide care management and utilization management services to members which include coordination of care, behavioral health consulting, and utilization review Serve Washington Medicaid and Medicare/ Dual eligible (DSNP) members telephonically Providing behavioral health education, coaching, care management, utilization management, and treatment decision support for members across a full continuum of care supporting member tenure in community as well as transitions from inpatient to community care settings Assess and interprets clinical records, member needs and requirements, and coordinate care for members transition of care needs as well as utilization and management of member benefits Identifies solutions to non-standard requests and problems actively working to resolve issues and needs Assessing current behavioral health status for members through utilization management in accordance with established level of care guidelines for pre-service and concurrent review of level of care re...Management, Behavioral Health, Remote, Substance Abuse, Mental Health, Benefits, Healthcare