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Utilization Management Specialist

2 months ago

Vancouver, United States Lifeline Connections Full time
Agency Background:
Lifeline Connections is a not-for-profit agency that is recognized as a leading behavioral health treatment provider in Washington State, offering a full continuum of care for individuals who have a behavioral health condition. Lifeline Connections' patients receive an unprecedented level of care from highly skilled professionals who know how to help people find and sustain long-term recovery. For over sixty years Lifeline Connections has provided hope, help and healing to thousands of individuals in Washington State and within the Portland, Oregon metro area.

$17.75 - $18.75 USD Hourly

MAJOR DUTIES: The Utilization Management Specialist will be responsible for performing ongoing utilization review and authorization for higher levels of care, including Substance Use Disorder Inpatient (IP), Withdrawal Management (Detox), and Intensive Outpatient (IOP) services. In fulfilling these duties, the incumbent performs the following duties independently:
  • Collaborates with the supervisory staff and Program Manager, other senior staff members, and counselors in building and maintaining clinical files sufficient to document and complete authorization.
  • Complete pre-certification for higher level of care admissions.
  • Application of medical necessity criteria in authorization of substance use services (ASAM)
  • Completes concurrent reviews and coordinates with clinicians on discharge planning and post-discharge follow up care.
  • Maintain complete and up to date files that document all services and contacts provided consistent with the requirements of Washington Administrative Code (WAC) and agency policy.
  • Data entry of all authorizations and clinical notes in clinical files.
  • Complete retro-reviews as assigned by supervisor and/or management staff.
  • Participate in scheduled staff meetings and trainings.
  • Participate in case staffing when needed.
  • Notify the Admissions Supervisor and the Quality Assurance department regarding. any quality indicators/concerns
  • Other duties as assigned.
KNOWLEDGE AND SKILLS REQUIRED BY THE POSITION
  • Bachelors degree or 3 years of relevant experience required.
  • Experience using ASAM Placement Criteria.
  • Experience conducting treatment authorizations with commercial insurance and/or managed care plans, preferred.
  • Must be capable of functioning autonomously while maintaining continuous communication with other staff members.
  • Knowledge of the various theories, forms, stages, and manifestations of addictive behavior, awareness of common manifestations of resistance to change in the addicted client, awareness of socio-cultural barriers to change, and an in-depth knowledge of alternative coping mechanisms to replace the use of chemicals.
  • Good verbal and written communication skills.
  • Great attendance.
  • Ability to work well with others.

Salary: $17.75-$18.75/hr DOE

Application Process:
To apply electronically for this position please click "Apply Now" or visit our ADP career center. For more information on this and other positions, please visit our website at www.lifelineconnections.org

The Benefits:

Lifeline Connections is striving to be your employer of choice by offering our regular/full-time employees a generous benefits package. The plan covers 85% of medical, dental, and vision costs at the employee level and 75% for all dependent plans. The majority of out-of-pocket costs for co-pays, prescriptions, and deductible under the medical plan are also covered. We also have employer paid Short Term Disability, Long Term Disability, Life Insurance and supplemental coverages.

Our full-time employees and some part time employees also qualify for our 401(K) plan that matches dollar for dollar up to 5%. On top of all that, our full-time employees receive approximately 4 weeks of paid time off during their first year of employment (accrual rates increase with years of service), as well as 1 personal holiday and 12 paid holidays per year

There are many other supplemental benefits we are glad to offer such as tuition reimbursement and discounted cellular service amongst others.

Send us your resume and let's talk about you joining our team