Behavioral Health Care Coordinator (RN or LISW)

Clinical Columbus, Ohio


The Behavioral Health Care Coordinator provides precertification and utilization management for all behavioral health/substance abuse levels of care as indicated per the Health Benefit Plan. Care coordination services are facilitated post discharge to ensure that members have a safe and effective transition to the next level of care.

Role and Tasks:

  • Provide precertification and utilization review on all inpatient mental health/substance abuse members
  • Provide utilization review on all proposed treatments for all levels of care as directed by the Health Benefit Plan
  • Maintain contact with internal clinical staff for transfer of cases for medical management when appropriate
  • Act as a clinical resource for all internal work groups
  • Maintain a working knowledge of all workflows related to Utilization management
  • Maintain a working knowledge of all benefit plans and know where to access the needed information
  • Negotiate for services needed if no clear benefit exists or if the services can only be provided out of network
  • Maintain open communication with Manager or designee 

Skills and Qualifications:

  • Registered nurse with active license in Ohio or
  • Licensed Independent Social Worker with active license in Ohio
  • Minimum of 2 year's experience in a Behavioral Health setting
  • Have a working knowledge of nationally accepted Behavioral Health medical necessity criteria
  • Ability to make decisions that are timely and well thought out that achieve results consistent with business goals and organizational culture
  • Possess excellent interpersonal communication skills
  • Excellent critical thinking skills
  • Ability to work independently with minimal supervision
  • Possess excellent computer skills including Microsoft applications
  • Possess excellent time management skills
Join our Quantum culture which rewards hard work while having fun!  Benefits include:
  • Paid Time Off and Paid Holidays
  • Medical/dental/vision insurance including domestic partner benefits
  • 401(k) with match up to 4%
  • On-site amenities include fitness facility, ping pong table, serenity room with massage chairs
  • Education reimbursement after a year of service
  • Engagement Teams allow for involvement throughout company
Quantum Health is an Equal Opportunity Employer