Behavioral Health Utilization Coordinator

Inland Northwest Behavioral Health; Spokane (WA); On-site; USD 65,000 - 85,000; Full time

Job summary

Inland Northwest Behavioral Health is seeking a Licensed Behavioral Health Professional as a Utilization Review/Utilization Management Coordinator. You will coordinate authorization and reimbursement activities to ensure patients receive appropriate levels of care throughout treatment.

The role requires a licensed behavioral health professional with ASAM and DSM-5 knowledge and the ability to advocate effectively with insurance providers.

Qualifications

• Master's degree in Social Work, Counseling, Marriage & Family Therapy, Psychology, or related behavioral health field.
• Current state licensure as LCSW/LICSW, LMHC, LPC, LMFT, or equivalent.
• Two years of experience in behavioral health or substance use disorder treatment.
• Working knowledge of ASAM criteria and DSM-5.
• Proficiency with electronic health records (EHR) and Microsoft Office.

Responsibilities

• Conduct telephonic and electronic utilization reviews with insurance companies and managed care organizations.
• Obtain initial, concurrent, and continued stay authorizations for patient treatment services.
• Utilize ASAM criteria and DSM-5 diagnostic criteria to determine medical necessity and appropriate levels of care.
• Assess treatment progress and support continued stay recommendations.
• Identify high-risk, complex, or denial-prone cases and collaborate with clinical leadership to address barriers to care.
• Partner with therapists, providers, and interdisciplinary teams to gather and communicate clinical information.
• Maintain accurate, timely, and compliant documentation of all utilization review activities.
• Track authorization status and ensure payer deadlines and requirements are met.
• Assist with appeals, reconsiderations, and denial management activities.
• Ensure compliance with accreditation standards, regulatory requirements, and organizational policies.
• Participate in quality improvement efforts related to utilization management and reimbursement processes.

Skills

Clinical assessment

Documentation

Communication

Electronic health records

Microsoft Office

Education

Master's degree in Social Work / related field

Tools

ASAM criteria

DSM-5

Job description

Inland Northwest Behavioral Health is seeking a Licensed Behavioral Health Professional as a Utilization Review/Utilization Management Coordinator. You will coordinate authorization and reimbursement activities to ensure patients receive appropriate levels of care throughout treatment.

The role requires a licensed behavioral health professional with ASAM and DSM-5 knowledge and the ability to advocate effectively with insurance providers.