Behavioral Health Utilization Coordinator

Horizon Health Corporation; Spokane (WA); On-site; USD 70,000 - 90,000; Full time

Job summary

Horizon Health Corporation in Spokane, WA seeks a Licensed Behavioral Health Professional to lead utilization review activities, coordinating authorizations and communicating with payers to ensure appropriate levels of care.

The role requires a master's in behavioral health, current state licensure (LCSW, LMHC, LPC, LMFT or equivalent), 2+ years of relevant experience, and strong ASAM/DSM-5 knowledge, with proficiency in EHR and MS Office.

Qualifications

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

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

ASAM criteria

DSM-5

Clinical assessment

Documentation

Communication

EHR proficiency

MS Office

Education

Master's in behavioral health

Job description

Horizon Health Corporation in Spokane, WA seeks a Licensed Behavioral Health Professional to lead utilization review activities, coordinating authorizations and communicating with payers to ensure appropriate levels of care.

The role requires a master's in behavioral health, current state licensure (LCSW, LMHC, LPC, LMFT or equivalent), 2+ years of relevant experience, and strong ASAM/DSM-5 knowledge, with proficiency in EHR and MS Office.