Utilization Management Supervisor (PPM III)

King-County,-W; Seattle (WA); On-site; USD 120,000 - 160,000; Full time

Job summary

King County Department of Community and Human Services seeks a Hospital and Mental Health Residential (HMHR) Treatment Utilization Management Supervisor to lead a MH Care Authorizers team and oversee utilization management for high-intensity MH programs.

The role focuses on ensuring medical necessity, coordinating care transitions, and driving quality assurance across the division, working with the BHRD and other county departments.

Qualifications

• Experience leading a MH care authorizers team in residential or high-intensity MH services.
• Strong knowledge of utilization management processes and timelines.
• Proven ability to drive quality assurance and contract compliance reviews.
• Proficient data collection, analysis and reporting for care transitions.
• Excellent collaboration with internal stakeholders and external providers.

Responsibilities

• Lead a team of MH Care Authorizers to ensure appropriate level of care.
• Participate as a key member of the BHRD Utilization Management Committee.
• Lead quality assurance activities, including site visits and contract reviews.
• Direct continuing stay reviews to ensure medical necessity per LOCUS.
• Coordinate care transitions and data reporting across the continuum.
• Engage with Behavioral Health and Recovery Division and other departments.

Skills

Team leadership

Utilization management

Quality assurance

Data analysis

Contract compliance

Project management

Stakeholder communication

LOCUS assessment

Tools

LOCUS assessment

Job description

King County's Department of Community and Human Services (DCHS) provides equitable opportunities for people to be healthy, happy, and connected to community.

At King County Department of Community and Human Services (DCHS), we believe in working as one team that solves problems—striving to be customer-focused and drive for the best results. We envision a welcoming community that is racially just. We believe the field of human services exists to undo and mitigate unfair structures. We seek to lead the way by working as respectful and responsible stewards for our community.

The Behavioral Health and Recovery Division (BHRD) of DCHS is seeking a Hospital and Mental Health Residential (HMHR) Treatment Utilization Management Supervisor (Project/Program Manager III). This position holds direct responsibility for the overall utilization management operations of the Hospital & Mental Health Residential Treatment Team.

The Supervisor will lead a team of Mental Health (MH) Care Authorizers responsible for ensuring that King County residents accessing MH residential care and other high‑intensity MH programs receive the appropriate level of care, appropriate services, and the support needed to step down to lower levels of care as they progress in their recovery. This position will participate as a key member of the BHRD Utilization Management Committee and will lead quality assurance activities, including site visits, contract compliance reviews, invoice reconciliation, and other monitoring tasks as assigned.

To be considered minimally qualified applicant must demonstrate a background that provides the knowledge, skills and ability to:

• Lead a team of MH Care Authorizers tasked with ensuring that King County residents that are accessing MH Residential care and other high intensity MH programs are accessing the level of care that is needed, are receiving appropriate services, and are receiving additional support needed to step down to lower levels of care and progress in their recovery
• Participate as a key member of the BHRD Utilization Management Committee
• Lead quality assurance activities, including site visits of mental health residential treatment providers, contract compliance reviews, invoice reconciliation, and other monitoring activities as assigned.
• Lead quality improvement activities, focused on improving oversight of the delivery of high intensity mental health services, improving flow between levels of care, and improving efficiencies in utilization management/care coordination.
• Complete and direct continuing stay reviews to determine that an individual continues to meet medical necessity standards commensurate to the current level of functioning as determined by the Level of Care Utilization System (LOCUS) Assessment.
• Supervise and monitor team of Mental Health Utilization Project-Program Manager II staff as part of a collaborative Utilization Management Team.
• Lead the collection, analysis, and reporting of utilization and care‑transition data to ensure timely progression of care, appropriate resource use, and optimal patient throughput across the continuum.
• Develop close coordination, partnership and communication within the Behavioral Health and Recovery Division (BHRD) and other Departments within the Department of Community & Human Services.
• Ensure continuing stay reviews meet Utilization Management Timelines established by BHRD’s Quality team and Managed