UM Clinician I: Optimize Care Transitions & Outcomes

Ultipro; Olympia, Tacoma (WA, WA); On-site; USD 72,000 - 95,000; Full time

Benefits offered by this job

Medical, Prescription, Dental, Vision

Telehealth app

401(k) retirement with match

PTO and holidays

Wellness programs

Job summary

Community Health Plan of Washington is seeking a Level I Utilization Management Clinician to perform utilization review and coordinate high-quality, cost-effective care. The role requires RN or LPN licensure and a bachelor’s degree, with 2+ years’ clinical experience in physical or behavioral health, and some prior utilization management exposure.

Travel to Pierce and Thurston Counties is required. You will support physician decision-making and collaborate with the health care team to ensure

Qualifications

• Bachelor's degree in a relevant field or equivalent education/experience.
• Current, unrestricted RN or LPN license.
• At least two years of clinical experience in physical or behavioral health.
• Experience in Utilization Management and Managed Care preferred.

Responsibilities

• Travel to local hospitals within Pierce and Thurston Counties.
• Review hospital notifications and prior authorization requests against guidelines.
• Coordinate discharge planning with facilities.
• Support members transitioning between care settings.
• Collaborate with providers and care teams to ensure timely care.
• Identify inappropriate or unnecessary services and suggest alternatives.
• Verify referrals and enrollment/benefits before authorizing care.
• Communicate findings to medical leadership and care teams.

Skills

Bachelor's degree in a relevant field

RN or LPN license

2+ years clinical experience

Utilization Management experience

Education

Bachelor's degree in a relevant field

Tools

MCG

InterQual

ASAM

LOCUS

Job description

Community Health Plan of Washington is seeking a Level I Utilization Management Clinician to perform utilization review and coordinate high-quality, cost-effective care. The role requires RN or LPN licensure and a bachelor’s degree, with 2+ years’ clinical experience in physical or behavioral health, and some prior utilization management exposure.

Travel to Pierce and Thurston Counties is required. You will support physician decision-making and collaborate with the health care team to ensure