Behavioral Health Care Coordinator

This position is responsible for conducting accurate and timely clinical reviews of behavioral health cases to assess medical necessity. The role includes direct member support via phone, clinical record review, and interpretation of behavioral health diagnoses in line with medical necessity criteria for all levels of behavioral health care, from outpatient services to acute inpatient treatment.

Conduct clinical reviews of behavioral health cases to determine medical necessity.
Communicate directly with members via telephone to provide support and guidance.
Review and interpret clinical documentation and medical records.
Apply contract interpretation and medical necessity criteria across varying levels of behavioral health services.
Collaborate with internal teams to ensure appropriate care coordination and service approvals.

Required Qualifications & Skills:
Master’s degree in a Behavioral Health field.
Active, current clinical license to practice independently (must be in good standing and valid in the state of operations).
Minimum of 3 years’ clinical experience in a psychiatric setting or private behavioral health practice.
Strong verbal and written communication skills.
Solid analytical thinking and decision-making abilities.Proficiency with PC systems and databases.