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 from the CCO level.

• Ensure that members receive medically appropriate services to enhance health outcomes.

• Evaluate authorization requests for completeness and solicit additional information as necessary.

• Assess medical, mental health, and substance use disorder information, making authorization decisions based on review criteria and clinical judgment.

• Issue decision notifications in accordance with established unit protocols.

• Analyze substance use disorder submissions for clinical quality, program structure, intervention level, and member participation.

• Collect, analyze, and compile documents related to appeals, reconsiderations, retrospective reviews, 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.

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

• Review and stay informed about contract expectations for authorizations.

• Travel to GOBHI locations as needed or requested.

• Participate in both internal and external multidisciplinary team meetings.

• Carry out other related tasks as assigned.

⛳️ Requirements

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

• Effective communication skills across multiple levels.

• Strong attention to detail, along with planning and organizational capabilities.

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

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

• Maintains a clean driving record and holds the required vehicle insurance.

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

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

• Availability to work occasional rotating on-call hours.

• Must reside within the State of Oregon.

• Willingness and ability to drive to GOBHI locations as necessary or requested.

🏝️ 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 hours.

• Company-funded 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 plan with 6.5% employer contributions.

• Reimbursements for cell phone and internet expenses.