Clinical Utilization Coordinator, Behavioral Health

Clive Behavioral; Spokane (WA); On-site; USD 60,000 - 80,000; Full time

Job summary

Clive Behavioral in Spokane, WA seeks a Licensed Behavioral Health Professional for a Utilization Review/Utilization Management Coordinator role. You will coordinate authorizations and reimbursements to ensure appropriate care levels and collaborate with Intake, Clinical Services, Medical Records, Business Office, Nursing, and Providers to communicate clinical information to payers.

The ideal candidate holds a Master’s in Social Work, Counseling, or related field, current licensure (LCSW/LICSW,

Qualifications

• Master's degree in Social Work, Counseling, Marriage & Family Therapy, Psychology, or related behavioral health field.
• Two years of experience in behavioral health and/or substance use disorder treatment.
• Working knowledge of ASAM criteria and DSM-5.
• Strong clinical assessment, documentation, and communication skills.
• 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

Clinical assessment

Documentation

Communication skills

EHR proficiency

MS Office

Education

Master's degree in Social Work/ Counseling/ MFT/ Psychology

Tools

Electronic Health Records

Microsoft Office

Job description

Clive Behavioral in Spokane, WA seeks a Licensed Behavioral Health Professional for a Utilization Review/Utilization Management Coordinator role. You will coordinate authorizations and reimbursements to ensure appropriate care levels and collaborate with Intake, Clinical Services, Medical Records, Business Office, Nursing, and Providers to communicate clinical information to payers.

The ideal candidate holds a Master’s in Social Work, Counseling, or related field, current licensure (LCSW/LICSW,