Job ID: 51123
Location: Jacksonville, FL
Category: Health Care, Nurse
Experience: At least 3 year(s)
Education: See Requirements
ABOUT THE POSITION
We are currently seeking a dynamic Patient Care Coordinator to join our team at our office in Jacksonville, FL. The Patient Care Coordinator provides utilization management (UM) of the behavioral health benefits for TRICARE South Contract beneficiaries. Conduct first and second level medical necessity reviews using professional knowledge, applying Beacon Health Options Clinical Criteria, ASAM criteria, most current DSM, URAC standards, recognized therapeutic modalities, treatment planning, pharmacology, and discharge planning review for all levels of behavioral health care for pre-authorization as well as concurrent care. Performs all duties within the scope of her/his licensure.
Perform assessment of clinical data received via telephonic, electronic and written transmission to determine TRICARE benefit, acuity of needs, appropriate level of care, appropriate services requested, and complete an authorization determination.
Acquire and appropriately apply knowledge of TRICARE Manuals, ValueOptions® Clinical Criteria, most current DSM, URAC standards, recognized therapeutic modalities, treatment planning, pharmacology, and discharge planning when performing first level medical necessity review.
Provide beneficiaries and external customers with accurate information regarding benefits and utilization management practices, in accordance to Policies and Procedures and Standard Operational Procedure (SOP).
Act as a resource and provides oversight and guidance and assistance to support functions assigned to non-clinical staff.
Assist with special projects and other duties assigned by management.
Provide assistance with calls that have been identified by non-clinical staff to be of a potential crisis situation (i.e., threaten of harm to self or others).
Education: Master’s Degree (in Social Work, or Marriage and Family Therapy, or Mental Health Counseling), Doctor of Philosophy (PhD), Doctor of Psychology (PsyD), or Associate’s Degree in Nursing required. Bachelor of Science Degree in Nursing preferred.
Relevant Work Experience: Minimum of three years clinical experience. Prefer psychiatric mental health/substance abuse field experience.
Licensures/Certifications: Current, Active, Unrestricted, Valid Florida License in Social Work, Marriage and Family Therapy, Psychology, Registered Nursing or as Licensed Mental Health Counselor (LMHC). LMHCs must meet TRICARE Policy Chapter 11, Section 11 as a TRICARE Certified Mental Health Counselor.
U.S. Citizen: Must demonstrate proof of U.S. Citizenship
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ValueOptions Federal Services, Inc., a Beacon Health Options company, 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