Behavioral Health Utilization Management Clinician I - MHP or SUDP

Community Health Plan of Washington; Seattle (WA); Remote; Full time

Job summary

An established industry player is seeking a Level I Utilization Management Clinician to join their team. This role involves performing utilization reviews for medical and behavioral health requests, ensuring timely access to care, and supporting physician decision-making. The ideal candidate will possess a relevant bachelor's degree, a current nursing or mental health license, and at least two years of clinical experience. This position offers a chance to make a significant impact on patient care while working in a supportive and inclusive environment. If you are passionate about improving health outcomes and thrive in a collaborative setting, this opportunity is perfect for you.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Retirement Plan

Overtime Pay

Flexible Work Schedule

Professional Development Opportunities

Qualifications

• Bachelor's degree or equivalent experience required.
• Current unrestricted RN, LPN, LICSW, LMHC, or LMFT license needed.

Responsibilities

• Conduct reviews of hospital notifications against clinical guidelines.
• Collaborate with facilities for discharge planning and care transitions.

Skills

Clinical Experience

Utilization Management

Communication Skills

Organizational Skills

Time Management

Education

Bachelor's Degree in Relevant Field

MHP or SUDP Credential

Tools

MCG Criteria

InterQual

ASAM

LOCUS

Job description

Requisition Number: BEHAV002559

Posted: January 9, 2025

Employment Type: Full-Time

Location: Remote (Washington State only)

Hourly Range: $35.21 USD to $54.57 USD

Who We Are

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our Commitment Is To:

• Strive to apply an equity lens to all our work.
• Become an anti-racist organization.
• Create an equitable work environment.

About the Role

The Level I Utilization Management Clinician performs utilization review for medical or behavioral health requests using established criteria, technologies, and tools. Responsibilities include supporting physician decision-making, ensuring timely access to care, and communicating effectively with all members of the health care team.

To Be Successful In This Role, You:

• Have a bachelor’s degree in a relevant field or an equivalent combination of education and highly relevant experience.
• Have a current, unrestricted license as an RN, LPN, LICSW, LMHC, or LMFT.
• Hold either a MHP (Mental Health Professional) or SUDP (Substance Use Disorder Professional) credential.
• Have at least two years of clinical experience in either a physical health or behavioral health setting.
• Have previous experience in Utilization Management and Managed Care (preferred).

Essential Functions and Responsibilities:

• Conduct reviews of hospital notifications or prior authorization care requests against established clinical guidelines and health plan policies.
• Conduct onsite visits to local facilities 1-3 times weekly to connect with members and support successful post-discharge transitions.
• Collaborate with facilities to perform discharge planning.
• Provide coordination support to members transitioning between care settings.
• Ensure high-quality care and appropriate services across the continuum of care.
• Identify potentially unnecessary services and recommend appropriate alternatives.
• Deliver timely written notifications to patients or family members.
• Communicate effectively with the medical director regarding identified variances.
• Participate as part of the care management team.
• Other duties as assigned.

Knowledge, Skills, and Abilities:

• Ability to manage quality standards for high volume of authorization.
• Ability to work independently and collaboratively.
• Effective written and verbal communication skills.
• Knowledge in criteria sets such as MCG, InterQual, ASAM, and LOCUS (preferred).
• Demonstrated organizational and time management skills.

Compensation and Benefits:

The position is FLSA Non-Exempt and is eligible for overtime. CHPW offers a comprehensive benefits package including medical, dental, vision, and 401(k) retirement plans.

Travel Required:

Yes, travel to local facilities to assist members with post-discharge.

Equal Opportunity Employer

CHPW is an equal opportunity employer and encourages all qualified applicants to apply.