Healthcare Access Navigator
2 weeks ago
The Utilization Management Clinician I at Community Health Plan of Washington plays a crucial role in ensuring that our members receive high-quality, cost-effective care. This position requires strong analytical skills, effective communication, and the ability to work collaboratively with healthcare teams to achieve optimal patient outcomes.
Key Responsibilities:
- Conduct thorough reviews of hospital notifications and prior authorization requests against established clinical guidelines and health plan policies.
- Collaborate with facilities to perform discharge planning and ensure seamless transitions between care settings.
- Provide coordination support to members transitioning between care settings or returning home from hospitalization, identifying member needs and ensuring necessary services are available during the transition period.
- Collaborate with providers, office staff, and Care Coordination team to assure coordination of care in a timely manner according to contractual and regulatory timeframes.
Requirements:
- Bachelor's degree in a relevant field or an equivalent combination of education and highly relevant experience.
- Current, unrestricted license as an RN or LPN.
- At least two years' clinical experience in either a physical health or behavioral health setting.
- Previous experience in Utilization Management and Managed Care preferred.
Estimated Salary Range: $62,400 - $83,500 per year, depending on experience and qualifications.
Benefits:
- Comprehensive benefits package including medical, prescription, dental, and vision coverage.
- Flexible spending accounts.
- Life insurance.
- Disability insurance.
- 401(k) retirement plan with employer match.
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