Utilization Management Coordinator

Job not on LinkedIn

🔥 3 minutes ago

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $85k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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GOBHI

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

GOBHI is a 501(c)(3) nonprofit corporation dedicated to administering behavioral health Medicaid benefits, non-emergent medical transportation, and community engagement across 12 rural and frontier counties in Oregon. Founded in 1994, it co-owns the Eastern Oregon Coordinated Care Organization with Moda Health, offering a variety of direct services statewide. GOBHI's initiatives include mental health and substance use disorder services, trauma-informed care, and support for older adults, among others, striving to foster healthier communities where individuals achieve their full potential.

📋 Description

• Provide clinical expertise in mental health and substance use disorder treatment services from the CCO level • Ensure medically appropriate services are provided to members and improve health outcomes • Review authorization requests for completeness and request additional information as needed • Review medical, mental health, and substance use disorder information and make authorization decisions based on review criteria and clinical judgment • Issue decision notices based on established unit protocols • Review substance use disorder submissions for clinical quality, program structure, intervention level, 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 to non-clinical Care Coordination staff involved with members • Provide technical assistance to providers in person and over video • Review and keep updated on contract expectations for authorizations • Drive to GOBHI locations as needed or requested • Participate in internal and external multidisciplinary team meetings • Perform other related duties as assigned

🎯 Requirements

• 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 • 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 • Must be located within the State of Oregon • Willingness/ability to drive to GOBHI locations as needed or requested

🏖️ Benefits

• 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