Utilization Management Coordinator (Remote in Oregon)

Greater Oregon Behavioral Health • Salem, OR

3d • Remote

About The Position

The Utilization Management Coordinator provides clinical expertise in mental health and substance use disorder treatment services at the CCO level to ensure medically appropriate services are provided to members and to improve health outcomes. The role includes reviewing service requests against medical necessity criteria, communicating review results to requesting providers, and participating in internal and external multidisciplinary team meetings. This is a remote office position, and the employee must be located in Oregon. The coordinator may need to travel to GOBHI locations as needed or requested and must be able to work occasional rotating on-call hours.

Requirements

• Five years of experience working with people who have a severe and persistent mental illness.
• Ability to communicate effectively at multiple levels.
• Strong attention to detail, planning, and organizational skills.
• Resourcefulness and ability to network and connect people with appropriate resources.
• Technology proficiency, including MS software or Google Suites.
• Good driving record and required vehicle insurance.
• Master’s degree in behavioral health.
• Licensed clinical social worker or licensed professional counselor.
• Ability to work occasional rotating on-call hours.

Nice To Haves

• Proven bilingual skills in Spanish qualify for additional compensation.

Responsibilities

• Review authorization requests to determine whether required information has been provided and request additional information as needed.
• Review medical, mental health, and substance use disorder information and make authorization decisions using review criteria and sound clinical judgment within the BHS scope of practice; consult with the Licensed Practitioner as needed.
• Issue decision notices according to established unit protocols.
• Participate in and review substance use disorder submissions for clinical quality, including program structure, level of intervention, and member engagement.
• Gather, analyze, and assemble 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 in person and over video.
• Review and stay current on contract expectations for authorizations.
• Drive to GOBHI locations as needed or requested.
• Perform other related duties as assigned.

Benefits

• Competitive salary starting at $85,000.
• Additional compensation for proven bilingual skills in Spanish.
• Medical, dental, and vision insurance for the employee and dependents.
• 22 paid time-off days and 10 paid holidays.
• Flexible working schedule.
• Company-paid life, short-term disability, and long-term disability insurance.
• FSA with a $500 employer contribution.
• Triple AAA insurance.
• Mileage reimbursement.
• Wellness benefits.
• 401(k) contribution, including 6.5% employer contributions.
• Cell phone and internet reimbursements.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level