Behavioral Health Utilization Specialist

Inland Northwest Behavioral Health; Spokane (WA); On-site; USD 65,000 - 90,000; Full time

Job summary

Inland Northwest Behavioral Health in Spokane, WA seeks a Licensed Behavioral Health Professional to coordinate authorization and reimbursement activities, ensuring patients receive appropriate levels of care throughout treatment. The role collaborates with Intake, Clinical Services, Medical Records, and payers to obtain timely authorizations and communicate clinical information.

The ideal candidate holds an active state license (LCSW/LICSW, LMHC, LPC, LMFT or similar), a master's in a

Qualifications

• Master's degree in a behavioral health field.
• Current state licensure as one of the following: 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.

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 knowledge

DSM-5 knowledge

Clinical assessment

Documentation skills

Communication skills

EHR proficiency

Microsoft Office

Education

Master's degree in Social Work, Counseling, Marriage & Family Therapy, Psychology, or related behavioral health field

Job description

Inland Northwest Behavioral Health in Spokane, WA seeks a Licensed Behavioral Health Professional to coordinate authorization and reimbursement activities, ensuring patients receive appropriate levels of care throughout treatment. The role collaborates with Intake, Clinical Services, Medical Records, and payers to obtain timely authorizations and communicate clinical information.

The ideal candidate holds an active state license (LCSW/LICSW, LMHC, LPC, LMFT or similar), a master's in a