Behavioral Health Utilization Management Clinician I - MHP or SUDP

This position is fully remote within Washington State only. 

Who we are

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

• Strive to apply an equity lens to all our work. 
• Reduce health disparities. 
• Become an anti-racist organization. 
• Create an equitable work environment. 

About the Role

The Level I Utilization Management Clinician performs utilization review for medical or behavioral health requests using utilization review criteria, technologies, and tools. Identifies, coordinates, and implements high quality, cost-effective alternatives when appropriate to the patient’s condition. Supports physician decision-making, working collaboratively with all members of the health care team, the patient, the patient’s family, co-workers, and internal and external customers to achieve optimal patient outcomes. Ensures members have timely access to care and supports during transitions between levels of care. Understands and effectively communicates requirements and follows Community Health Plan of Washington (CHPW) policies and procedures.

To be successful in this role, you:

• Have a bachelor’s degree in a relevant field or an equivalent combination of education and highly relevant experience.
• Have a current, unrestricted license as an RN, LPN, LICSW, LMHC or LMFT.
• Have either a MHP (Mental Health Professional) or SUDP (Substance Use Disorder Professional) credential.
• Have at least two years clinical experience in either a physical health or behavioral health setting.
• Have previous experience in Utilization Management and Managed Care, preferred.

Essential functions and Roles and Responsibilities:

• Conduct review of hospital notification or prior authorization care requests against established clinical guidelines and health plan policies.
• Conduct onsite visits to local facilities 1-3 times weekly to connect with members and support successful post-discharge transitions.
• Collaborate with facilities to perform discharge planning.
• Provide coordination support to members transitioning between care settings or returning home from a hospitalization. Identifies member needs and provides support to ensure necessary services are available during the transition period.
• Collaborates with providers, office staff, and Care Coordination team to assure coordination of care in a timely manner according to contractual and regulatory timeframes.
• Identifies, coordinates, and ensures high quality care and appropriate care by focusing on supporting access to …