Utilization Management Specialist - Mental Health - Scheduled On Call (Remote - Local residency[...]

Kaiser Permanente Northwest; Portland (OR); Remote; USD 75,000 - 95,000; Full time

Job summary

A leading health care organization is seeking a Utilization Management Specialist for Mental Health to oversee benefit authorizations and serve as a contact for members. This full-time role includes responsibilities for care coordination and requires local residency for remote work. Ideal candidates will have a Master's degree and 3+ years of relevant experience.

Qualifications

• Minimum 3 years experience with mental health or chemical dependency conditions.
• Master's degree in related field required.
• Understanding of medical necessity criteria and DSM diagnoses.

Responsibilities

• Manage behavioral health benefits and provide medical necessity determinations.
• Explain benefits, identify resources, and schedule appointments.
• Facilitate communication among providers regarding treatment and outcomes.

Skills

Clinical judgment

Communication

Organizational skills

Education

Master's degree in mental health, social work, or related field

Tools

Microsoft Office

Analytical software

Job description

Utilization Management Specialist - Mental Health - Scheduled On Call (Remote - Local residency required)

Join to apply for the Utilization Management Specialist - Mental Health - Scheduled On Call (Remote - Local residency required) role at Kaiser Permanente Northwest.

Job Summary

Ensure consistent application and management of Kaiser Permanente mental health and chemical dependency benefits.

Responsibilities

• Benefit payment authorizations: Manage behavioral health benefits by providing medical necessity determinations based on current clinical information and Kaiser criteria.
• Member contact: Explain benefits, identify resources, and schedule appointments.
• Payment denials: Follow policies, explain denials to providers and members.
• Consultations: Advise internal and external providers on medical necessity, benefits, and resources.
• Fraud and abuse: Ensure proper expenditure of healthcare dollars according to policies and laws.
• Continuity of care: Facilitate communication among providers regarding treatment and outcomes.
• Care coordination: Ensure discharge plans meet HEIDIS guidelines.
• On-call rotation: Cover pre-authorizations outside of regular hours.

Qualifications

Experience

• Minimum 3 years working with individuals with mental health or chemical dependency conditions.
• Minimum 2 years in utilization management and discharge planning.

Education

• Master's degree in mental health, social work, or related field.

Additional Requirements

• Understanding of medical necessity criteria and DSM diagnoses.
• Knowledge of community resources and behavioral health benefits.
• Strong clinical judgment, communication, and organizational skills.
• Proficiency with medical records, Microsoft Office, and analytical software.

Preferred Qualifications

• 5+ years experience with mental health or chemical dependency conditions.
• Relevant state licensure (e.g., LCSW, LMFT, LPC, Psychologist, CADC, LICSW, LASW, LMHC, etc.).
• Knowledge of UM processes, Kaiser resources, and insurance operations.

Additional Information

Position is full-time, mid-senior level, in health care industry, with on-call responsibilities. The role is remote but requires local residency.