Utilization Management Coordinator

This is a fully remote position, open to applicants in Oregon.

📋 Description

• Deliver clinical expertise in the treatment services for mental health and substance use disorders at the CCO level.

• Ensure that medically appropriate services are offered to members, aiming to enhance health outcomes.

• Assess authorization requests for completeness and solicit additional information when necessary.

• Evaluate medical, mental health, and substance use disorder data to make authorization decisions based on review criteria and clinical judgment.

• Issue decision notifications in accordance with established unit protocols.

• Examine substance use disorder submissions for clinical quality, intervention levels, and member engagement.

• Collect, analyze, and compile documents for appeals, reconsiderations, retrospective reviews, and secondary review requests.

• Work collaboratively with community providers, state and county case workers, vendors, agencies, Choice contractors, wraparound teams, and other pertinent parties.

• Provide guidance to non-clinical Care Coordination personnel.

• Offer technical assistance to providers both in person and via video.

• Stay updated on contract expectations relating to authorizations.

• Travel to GOBHI locations as required or requested.

• Undertake additional related responsibilities as assigned.

⛳️ Requirements

• Five years of experience working with individuals who have severe and persistent mental illnesses.

• Strong communication skills across multiple levels.

• Excellent attention to detail, along with strong planning and organizational abilities.

• Resourceful and capable of networking to connect individuals with the appropriate resources.

• Proficient in technology, including MS software and Google Suites.

• Maintains a clean driving record and possesses the necessary vehicle insurance.

• A Master’s degree in behavioral health is mandatory.

• Must be a licensed clinical social worker or licensed professional counselor.

• Availability to work occasional rotating on-call hours is required.

🏝️ Benefits

• Additional compensation for verified bilingual skills in Spanish.

• Medical, dental, and vision insurance for you and your dependents.

• 22 Paid Time Off Days and 10 paid Holidays.

• Flexible working schedule.

• Company-paid life, short-term disability, and long-term disability insurance.

• Flexible Spending Account (FSA), with a $500 employer contribution.

• Triple AAA insurance coverage.

• Mileage reimbursement.

• Wellness benefits.

• 401k contribution plan, including 6.5% employer contributions.

• Reimbursements for cell phone and internet expenses.