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.

• Evaluate service requests in accordance with medical necessity criteria.

• Communicate review outcomes to requesting providers.

• Engage in both internal and external multidisciplinary team meetings.

• Assess authorization requests and solicit additional information as required.

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

• Issue decision notices following established unit protocols.

• Evaluate substance use disorder submissions for clinical quality, program structure, level of intervention, and member involvement.

• Collect, analyze, and compile documentation related to appeal, reconsideration, retrospective review, and second review requests.

• Collaborate with community providers, state and county case workers, vendors, agencies, Choice contractors, wraparound teams, and other relevant stakeholders.

• Guide non-clinical Care Coordination staff working with members.

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

• Stay informed about contract expectations for authorizations.

• Travel to GOBHI locations as necessary or upon request.

• Carry out additional related duties as assigned.

⛳️ Requirements

• Minimum of five years’ experience working with individuals who have severe and persistent mental illnesses.

• Effective communication skills at various levels.

• Excellent attention to detail, planning, and organizational abilities.

• Resourceful, with the ability to network and connect individuals to suitable resources.

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

• Maintains a good driving record and possesses the required vehicle insurance.

• Master's degree in behavioral health is mandatory.

• Must hold a license as a clinical social worker or professional counselor.

• Availability to work occasional rotating on-call hours.

• Must reside within the State of Oregon.

• Willingness and ability to travel to GOBHI locations as needed or requested.

🏝️ Benefits

• Additional compensation for verified bilingual skills in Spanish.

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

• 22 Paid Time Off Days and 10 paid Holidays.

• Flexible working schedule options.

• 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 available.

• Wellness benefits provided.

• 401k plan with employer contributions of 6.5%.

• Reimbursements for cell phone and internet expenses.