Utilization Management Clinician I
4 weeks ago
Community Health Plan of Washington is seeking a highly skilled Utilization Management Clinician I to join our team. As a key member of our clinical staff, you will play a vital role in ensuring our members receive high-quality, cost-effective care.
Key Responsibilities:
- Conduct thorough reviews of hospital notifications and prior authorization requests to ensure compliance with established clinical guidelines and health plan policies.
- Collaborate with healthcare facilities to perform discharge planning and ensure a smooth transition of care for our members.
- Provide coordination support to members transitioning between care settings or returning home from a hospitalization, identifying their needs and ensuring necessary services are available during the transition period.
- Work closely with providers, office staff, and the Care Coordination team to ensure timely coordination of care according to contractual and regulatory timeframes.
- Identify and address potential unnecessary services and/or delivery settings, recommending alternative solutions that prioritize high-quality care and patient outcomes.
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 of clinical experience in a physical health or behavioral health setting.
- Previous experience in Utilization Management and Managed Care is preferred.
What We Offer:
- A dynamic and supportive work environment.
- Competitive compensation and benefits package.
- Opportunities for professional growth and development.
How to Apply:
Please submit your application, including your resume and cover letter, to [insert contact information]. We look forward to hearing from you
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