SUD Care Coordination & Utilization Manager

Pmhcc,-Inc.-1; Philadelphia (Philadelphia County); On-site; USD 54,000 - 66,000; Full time

Job summary

PMHCC, Inc. in Philadelphia is seeking a Substance Use Disorder Management Specialist to lead utilization management and care coordination, ensuring access to medically necessary behavioral health services.

The role requires strong clinical skills, collaboration with partners, and adherence to HIPAA. Salary listed is $60,000 annually, with duties spanning provider management and quality monitoring.

Qualifications

• Bachelor’s or Master’s degree with relevant SUD experience.
• Strong clinical case conceptualization and advocacy.
• Knowledge of HIPAA regulations.
• Ability to coordinate care and use ASAM Criteria.

Responsibilities

• Authorize and reauthorize treatment using ASAM Criteria.
• Coordinate care with system partners to address social determinants and member needs.
• Liaise with provider agencies as primary contact.
• Authorize continuation or adjust levels of care as needed.
• Perform on-site utilization reviews and required paperwork.
• Monitor eligibility via PROMISe & e-CIS systems.
• Maintain documentation in electronic systems.
• Train and support new staff as requested.

Skills

Clinical case conceptualization

Advocacy & listening

Meeting facilitation

Psychiatric/medical knowledge

Verbal & written communication

Interpersonal skills

MS Office (Excel)

Independent & team work

Time management

HIPAA compliance

Education

Bachelor’s degree + SUD experience

Bachelor’s degree + 5 years SUD

Master’s degree + 2 years SUD

Master’s degree + 3 years SUD

Job description

PMHCC, Inc. in Philadelphia is seeking a Substance Use Disorder Management Specialist to lead utilization management and care coordination, ensuring access to medically necessary behavioral health services.

The role requires strong clinical skills, collaboration with partners, and adherence to HIPAA. Salary listed is $60,000 annually, with duties spanning provider management and quality monitoring.