Utilization Management Coordinator

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

📋 Description

• Evaluate authorization requests to ascertain if all necessary information has been submitted and request further details as required.

• Assess medical, mental health, and substance use disorder information, making authorization decisions based on review criteria and sound clinical judgment within the BHS scope of practice.

• Generate decision notices in accordance with established unit protocols.

• Engage in the review of substance use disorder submissions, focusing on the clinical quality of program structure, level of intervention, and member engagement.

• Collect, analyze, and compile documents pertaining 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.

• Offer guidance to non-clinical Care Coordination personnel involved with the member.

• Provide technical support to providers both in person and via video conferencing.

• Review and stay informed about contract expectations regarding authorizations.

• Travel to GOBHI locations as required or requested.

• Perform other related tasks as assigned.

⛳️ Requirements

• A minimum of five years’ experience working with individuals who have severe and persistent mental illness.

• Proficient in effective communication across various levels.

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

• Resourceful, capable of networking and connecting individuals to suitable resources.

• Technologically adept – skilled in using MS software or Google Suites.

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

• Master’s degree in behavioral health is required.

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

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

🏝️ Benefits

• Additional compensation for demonstrated bilingual proficiency 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 insurances.

• FSA with a $500 employer contribution.

• Triple AAA insurance.

• Mileage reimbursement.

• Wellness benefits.

• 401k contributions, including a 6.5% employer match.

• Reimbursements for cell phone and internet expenses.