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Inpatient Coordinator
Organization Overview
Commonwealth Care Alliance is a rapidly growing nonprofit organization providing integrated health care and social support services to people with complex medical needs. Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Our innovative care model is nationally recognized for its effectiveness in improving health outcomes for these vulnerable populations.
Our unique care model is empowering for our employees as well as our members. Whether you are a clinical or administrative professional, all of us at Commonwealth Care Alliance receive the satisfaction of knowing our work truly makes a difference. We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package.
Position Summary
The Behavioral Health (BH) Inpatient Coordinator for Inpatient Management will assist the Behavioral Health Coordinator with Inpatient Management review inpatient behavioral health and substance abuse admissions, for medical necessity and appropriate level of care, negotiating payment levels with facilities and assist with transition of care planning and coordination.
Key Responsibilities
  • Conduct telephonic preadmission, concurrent and retrospective clinical review of focused behavioral health and substance abuse inpatient admissions through application of evidence-based medical necessity criteria, CCA policies and procedures, and regulatory and legislative requirements
  • Focus on effective and appropriate utilization of alternative levels of care and collaborate with ICT and Inpatient staff to explore all diversionary services and step down placements to ensure member receives appropriate level of care in least restrictive environment
  • Determine medical necessity and level of care based on the consistent application of decision support tools, and communicate decisions to facility, providers, treatment team and member
  • Interact with facility staff, primary care teams and other treatment team members to evaluate transition of care needs and prepare member and family for discharge
  • Coordinate authorization and/or delivery of post-acute services and coordinate follow-up care to ensure plans for continuity of care and adherence to quality standards.
  • Understand and appropriately manage member's benefits to maximize health care quality
  • Interface with Primary/Interdisciplinary Care Team including Care Coordinator, Care Manager, and others to consult on clinical decision making, optimize member care and ensure safe and effective hand-offs and transitions
  • Position requires the ability to travel to facility or primary care sites within Massachusetts
  • Periodic coverage for colleagues serving members in the Senior Care Options Program and the Integrated Care Organization
  • After hours on call responsibility
Education Requirements
  • Bachelor's Degree or equivalent experience
  • Master's degree in Behavioral Health field preferred
  • LICSW, LCSW, LMHC preferred, licensed eligible required
Experience Requirements
  • Minimum of 3 years’ experience in psychiatric and/or substance abuse health care settings
  • Demonstrated knowledge of utilization review procedures
  • Demonstrated knowledge of mental health and substance abuse community resources and network providers
  • Skilled in negotiation and motivational interviewing
Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws

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