Coord Clncl Liaison/Spec Needs

Position Summary: 

Under the supervision of the Integrated Healthcare Management Manager, the Behavioral Health Coordinator/Clinical Liaison is responsible for identifying, assessing, planning, coordinating, and implementing appropriate, cost-effective, and quality healthcare services for individuals requiring additional assistance in accessing behavioral health services. Acts as a liaison between the Health Plan and regulatory agencies. Works collaboratively with all Health Plan departments and providers to facilitate cost-effective care and improve member outcomes.

Essential Responsibilities

• Acts as a liaison between regulatory agencies, the Health Plan, behavioral health members, caregivers, healthcare providers, and payors.

• Investigates and assists in the resolution of issues referred to the Health Plan from the Medicaid agency including, but not limited to, pharmacy, claims, member appeals, medical and dental provider network issues, care delivery, access to care, expedited enrollment, and residential and long-term placement for behavioral health members.

• Participates in meetings, conference calls, and case discussions with government agencies and/or providers including, but not limited to, on-site Behavioral Health Monitoring meetings, Joint Treatment Plan Conferences, PH-MCO/BH-MCO meetings, Juvenile Court Services, and Integrated Health Homes (IHH).

• Collaborates with Statutory Reporting and Medical Informatics in the preparation and review of monthly Behavioral Health reports. Provides monthly reports and analysis of operations and services as required by departmental guidelines and regulatory requirements.

• Functions as a liaison with community organizations and healthcare providers. Supports and assists providers and advocates for behavioral health members in resolving questions regarding access to covered care and services.

• Supports IHCM staff as they work with members, caregivers, PCPs, specialists, and providers to resolve issues affecting individual members or behavioral health populations. Monitors and coordinates reporting and resolution of issues to the Medicaid agency or other responsible government agencies.

• Performs other duties and projects as assigned.

Work Arrangement: Remote – Anywhere within the State of New Hampshire.

Education and Experience: 

• Bachelor’s Degree required.

• Registered Nurse (RN) required.

• Licensed Social Worker (LSW) preferred. 
• Knowledge of systems and resources in New Hampshire preferred

• 3 years of experience working with behavioral health and/or Medicaid populations. 5+ years is strongly preferred.

• 5 years of clinical nursing or behavioral health experience.

Our Comprehensive Benefits Package
Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.

Why Join Us: Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you are driven to make a difference, we want to hear from you.

About AmeriHealth Caritas
Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at http://www.amerihealthcaritas.com