Job Description

Job Title: Licensed Alcohol and Drug Counselor (LADC)

About the Role

As a Licensed Alcohol and Drug Counselor (LADC), you will play a critical role in implementing effective utilization management strategies. This includes evaluating the appropriateness of healthcare services, applying clinical criteria to ensure optimal resource use, identifying opportunities for case management, and resolving quality issues. You will also educate providers and members, analyze healthcare delivery data, and support continuous improvement in provider and member satisfaction.

Key Responsibilities

• Conduct pre-service and retrospective reviews using clinical expertise and health plan knowledge.
• Evaluate medical documentation and claims data to ensure appropriate utilization and identify opportunities for case management.
• Maintain high levels of service and confidentiality across all member and provider interactions.
• Document clinical decisions and rationale clearly and in compliance with regulatory standards.
• Identify trends and recommend workflow improvements.
• Mentor and coach team members; serve as a preceptor when needed.
• Collaborate with internal and external stakeholders to enhance healthcare outcomes.
• Educate providers to streamline processes and strengthen network relationships.
• Review provider claims for accuracy, resolve discrepancies, and ensure timely payments.
• Monitor healthcare service delivery and develop strategies for performance improvement.

Required Qualifications

• Active and unrestricted Minnesota license as a Licensed Alcohol and Drug Counselor (LADC) or other licensed behavioral health clinician (e.g., LICSW, LPCC, LMFT, LP).
• Minimum of 3 years of progressive clinical experience.
• Strong analytical and problem-solving skills.
• Excellent organizational and time management abilities.
• Proficiency in PC-based software and systems.
• Ability to work independently and collaboratively.
• High school diploma or equivalent.
• Legal authorization to work in the U.S.

Preferred Qualifications

• 5+ years of clinical experience.
• 1+ years of experience in managed care (e.g., utilization management, case management, auditing).
• Certification in utilization management or a related field.
• Experience in UM/CM/QA/Managed Care.
• Familiarity with state and federal regulatory policies and provider agreements.
• Coding experience (ICD-10, HCPCS, CPT).

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