Care Coordinator

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 non-profit 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 as-needed 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 up-to-date 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 Record-Keeping:
• 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 Value-Based Purchasing spreadsheet to track ASAM Level 3.5 residential bed admissions and related performance metrics.
• Peer-to-Peer Reviews, Appeals and Denials Management:

• Coordinate and complete peer-to-peer 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 (As-Needed):
• Provide clinical services on an as-needed 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

• Master’s 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 time-management 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 non-smoking facility.

We are an Equal Opportunity Employer and Provider of Services.