Care Coordinator
Care Coordinator
Posted on :
17-05-2025
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1 Vacancy
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Job Description
Are you a Master level licensed Counselor/Social Worker looking for a new opportunity CHC Addiction Services is looking for new members to join our team!
CHC Addiction Services is a nonprofit social service agency in the Akron area whose mission is to treat inspire support and empower individuals and families impacted by the disease of addiction.We are currently looking for a Care Coordinator.
CHC Addiction Services is a nonprofit social service agency in the Akron area whose mission is to treat inspire support and empower individuals and families impacted by the disease of addiction.We are currently looking for a Care Coordinator.
Position Summary:
The Care Coordinator is responsible for preparing writing editing and submitting prior authorization requests for ASAM Level 3.5 residential substance use disorder (SUD) treatment services to Medicaid payers. This role ensures all clinical documentation supports medical necessity and complies with payer requirements and applicable regulations. The Care Coordinator works closely with residential clinical teams to coordinate documentation and care planning attends weekly clinical meetings to remain informed on client progress and is available to provide direct clinical services on an asneeded basis to support client care and program operations.
Key Duties and Responsibilities:
- Clinical Documentation Review:
- Analyze patient clinical records assessments and treatment plans to determine eligibility and appropriateness for ASAM Level 3.5 residential care.
- Ensure documentation aligns with ASAM criteria and Medicaid requirements for medical necessity.
- Prior Authorization Submission:
- Prepare and submit prior authorization and reauthorization requests for Medicaid and managed Medicaid plans.
- Write clear concise and clinically accurate summaries that support medical necessity.
- Edit and proofread submissions to ensure accuracy consistency and compliance with payer policies.
- Maintain an organized tracking system for authorizations to ensure timely submissions reauthorizations and appeals in alignment with payer deadlines.
- Residential Team Collaboration:
- Actively collaborate with residential clinical teams including clinicians case managers medical staff and program leadership to ensure alignment of treatment planning with payer criteria.
- Attend weekly clinical meetings at each residential facility to gather uptodate clinical information on client progress and needs.
- Participate in interdisciplinary team meetings to support utilization management efforts and improve submission outcomes.
- Communication and Coordination:
- Coordinate with treatment teams including clinicians intake staff and case managers to gather and clarify necessary documentation.
- Communicate with Medicaid representatives and managed care organizations (MCOs) regarding submission requirements missing information or appeals.
- Communicate with the billing and finance teams to ensure all clients admitted to 3.5 residential care have active Medicaid coverage at the time of admission and throughout their stay.
- Regulatory Compliance and RecordKeeping:
- Maintain detailed and accurate records of all submissions approvals denials and communications.
- Stay current with state Medicaid policies ASAM guidelines and other regulatory standards affecting SUD residential treatment.
- Ensure compliance with internal workflows and external payer timelines to prevent delays or lapses in client coverage.
- Maintain and regularly update a ValueBased Purchasing spreadsheet to track ASAM Level 3.5 residential bed admissions and related performance metrics.
- PeertoPeer Reviews Appeals and Denials Management:
- Coordinate and complete peertopeer reviews to advocate for medical necessity providing additional information as needed.
- Prepare appeal letters and supplemental documentation in response to denials.
- Track outcomes of appeals and modify future submissions accordingly to improve approval rates.
- Direct Clinical Support (AsNeeded):
- Provide clinical services on an asneeded basis which may include conducting biopsychosocial assessments facilitating group or individual sessions or supporting crisis intervention efforts.
- Step in to cover clinical responsibilities during staff absences or periods of high client need.
Minimum Qualifications:
- Masters degree in Counseling Social Work or a related field (LPC LPCC LSW MSW etc. preferred).
- Minimum 2 years of experience in utilization review prior authorization or clinical documentation related to substance use treatment.
- Knowledge of ASAM Criteria particularly Level 3.5 residential care standards.
- Familiarity with Medicaid and managed care organization (MCO) processes and guidelines.
- Strong writing and editing skills with an ability to translate clinical language into compelling medical necessity narratives.
- Excellent organizational communication and timemanagement skills.
- Comfort with technology and the ability to learn electronic health records (EHR) systems and prior authorization submission platforms.
Why you would love working for CHC:
- Medical dental and vision benefits for employees working 30 hours weekly!
- 32 paid days off per year! (holidays vacation personal and sick days!)
- Referral Bonuses!
- 403b with company match after one year!
- Professional licensure fee reimbursement!
- Company Sponsored Training Opportunities based on position
- Employee Assistance Program (including Health Management Family Support and Financial Advice/Assistance)!
CHC Addiction Services is a nonsmoking facility.
We are an Equal Opportunity Employer and Provider of Services.
Required Experience:
IC
Employment Type
Full Time
Key Skills
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