Job Type
Full-time
Description
Greater Oregon Behavioral Health, Inc. (GOBHI) has an immediate opening for a Utilization Management Coordinator. This key position is a remote office position and needs to be located within the State of Oregon.
The Utilization Management Coordinator provides clinical expertise in mental health and substance use disorder treatment services from the CCO level for the purpose of ensuring medically appropriate services are provided to members and improving health outcomes. Core job tasks include clinical review of requests for services against medical necessity criteria, informing requesting providers of results of reviews, and participating in internal and external multidisciplinary team meetings.
Essential duties include:- Review authorization requests to determine if needed information has been provided and request additional information as needed.
- Review medical, mental health and substance use disorder information and make authorization decisions based on review criteria and sound clinical judgment within the BHS scope of practice and review with the Licensed Practitioner as needed.
- Issue decision notices based on established unit protocols.
- Participate and review substance use disorder submissions for clinical quality of program structure, level of intervention, and member engagement.
- Gather, analyze and assemble the documents 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 parties.
- Provide direction as appropriate to non-clinical Care Coordination staff involved with the member.
- Provide technical assistance to providers both in person and over video.
- Review and keep updated on contract expectations for authorizations.
- Drives to GOBHI locations as needed or requested.
- Performs other related duties as assigned.
Requirements
What is needed to succeed in this role:- Five years' experience working with those who have a severe and persistent mental illness.
- Ability to communicate effectively at multiple levels.
- Strong attention to detail, planning, and organizational skills.
- Resourceful, able to network and connect people to appropriate resources.
- Technology savvy - proficient using MS software or Google Suites.
- Maintains good driving record and required vehicle insurance.
- Education - Master's degree in behavioral health required.
- Licensed clinical social worker or licensed professional counselor.
- Must be able to work occasional rotating on call hours.
What we offer:- Competitive salary - starting at $85,000
- Additional compensation for proven bilingual skills in Spanish
- Medical, dental and vision insurance for you and 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 contribution, including 6.5% employer contributions
- Cell phone and internet reimbursements
