13 Care Coordinator(RN/LMSW/Licensed Counselor or Psychologist) Jobs in Columbia, SC
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Pyramid Consulting, Inc. is Hiring a Care Coordinator(RN/LMSW/Licensed Counselor or Psychologist) Near Columbia, SC
Job ID: 24-03585
Pay Range: $30/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions.
- Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness.
- Utilizes available resources to promote quality, cost effective outcomes.
- 50% Performs medical or behavioral review/authorization process.
- Ensures coverage for appropriate services within benefit and medical necessity guidelines.
- Assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions.
- May initiate/coordinate discharge planning or alternative treatment plans as necessary and appropriate. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits.
- 20% Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.).
- Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
- 10% Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans.
- Serves as member advocate through continued communication and education.
- Promotes enrollment in care management programs and/or health and disease management programs. Provides telephonic support for members with chronic conditions, high risk pregnancy or other at risk conditions that consist of: intensive assessment/evaluation of condition, at risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behaviour change and increase member program engagement.
- 10% Maintains current knowledge of contracts and network status of all service providers and applies appropriately.
- Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.
- 10% Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
- Working knowledge of word processing software.
- Ability to work independently, prioritize effectively, and make sound decisions.
- Good judgment skills.
- Demonstrated customer service, organizational, and presentation skills.
- Demonstrated proficiency in spelling, punctuation, and grammar skills.
- Demonstrated oral and written communication skills.
- Ability to persuade, negotiate, or influence others.
- Analytical or critical thinking skills.
- Ability to handle confidential or sensitive information with discretion.
- Microsoft Office.
- Working knowledge of spreadsheet, database software.
- Knowledge of contract language and application.
- Thorough knowledge/understanding of claims/coding analysis/requirements/processes.
- Working knowledge of Microsoft Excel, Access or other spreadsheet/database software.
- Associate Degree - Nursing or Graduate of Accredited School of Nursing or Master's degree in Social Work, Psychology, or Counselling.
- 2 years clinical experience.
- Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LMSW (Licensed Master of Social Work) licensure from the United States and in the state of hire, OR active, unrestricted licensure as Counselor, or Psychologist from the United States and in the state of hire.
- Bachelor's degree- Nursing. Preferred.
- 7 years-healthcare program management, utilization review, or clinical experience in defined specialty.
- Specialty areas are oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery.
- Work Environment:
- Typical office environment.
- Employee may work from one's/out of one's home.
- May involve some travel within one's community.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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Job Summary
Contractor
IT Outsourcing & Consulting
$64k-83k (estimate)
03/25/2024
04/16/2024
pyramidci.com
CHARLOTTE, NC
1,000 - 3,000
1996
Private
EMMA ADAMS
$200M - $500M
IT Outsourcing & Consulting
Related Companies
About Pyramid Consulting, Inc.
Pyramid Consulting is a recruitment process outsourcing firm that provides software development and IT staffing solutions.
The job skills required for Care Coordinator(RN/LMSW/Licensed Counselor or Psychologist) include Mental Health, Customer Service, Social Work, Health Care, Written Communication, Analysis, etc. Having related job skills and expertise will give you an advantage when applying to be a Care Coordinator(RN/LMSW/Licensed Counselor or Psychologist). That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Care Coordinator(RN/LMSW/Licensed Counselor or Psychologist). Select any job title you are interested in and start to search job requirements.
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Quotes from people on Care Coordinator job description and responsibilities
A care coordinator helps track the patient’s health and plans the daycare.
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The care coordinator also connects with the patient's family regularly to update them on the patient's progress.
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Some care coordinators may also require to be on-call regularly for medical emergencies sometimes too.
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They monitor and coordinate patients' treatment plans, educate them about their condition, connect them with health care providers, and evaluate their progress.
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