Utilization Management Clinician I

4 weeks ago


Lake Oswego, Oregon, United States Community Health Plan of Washington Full time
Job Overview

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


  • Nurse Clinician

    1 month ago


    Lake Oswego, Oregon, United States Kaiser Permanente Full time

    Job Summary:The Registered Nurse participates as a member of the healthcare team in delivering quality healthcare to patients, which supports Kaiser Permanente's mission, vision, and values. The RN provides a variety of nursing services in person and/or by phone utilizing the nursing process and leadership skills to address acute and chronic needs of Health...


  • Lake Oswego, Oregon, United States Cayuga Centers Full time

    About the PositionCayuga Centers is seeking a skilled Clinician to provide therapy, counseling, and coaching services to children and families in a community-based setting. As a member of our innovative Children and Family Treatment and Support Services team, you will work with families to address challenges associated with behavioral health needs through...

  • Clinical Therapist

    4 weeks ago


    Lake Oswego, Oregon, United States Cayuga Centers Full time

    About the RoleCayuga Centers is seeking a skilled Clinician to join our innovative Children and Family Treatment and Support Services team. As a member of our team, you will provide therapy, counseling, and coaching services to children and families in the home and/or community.Key ResponsibilitiesImplement a variety of therapeutic interventions/modalities...


  • Lake Oswego, Oregon, United States CenterWell Home Health Full time

    Clinical Management Role at CenterWell Home HealthAs a Clinical Manager with CenterWell Home Health, you will oversee direct care patient services provided by clinical personnel. Your primary responsibility is to coordinate and implement clinical operations for a specific location, ensuring seamless delivery of care to patients.About the RoleYou will...


  • Lake Oswego, Oregon, United States Gpac Full time

    I am excited to work with a prominent agricultural and food processor seeking an experienced Talent Acquisition Manager for their Western Region facilities. This dynamic company is one of the top producers in their industry, driven by recent growth.The ideal candidate will possess 3+ years of Talent Acquisition experience within food manufacturing,...


  • Lake Oswego, Oregon, United States Nascentia Health Full time

    Job Summary:The Registered Nurse Case Manager is a vital member of our team at Nascentia Health, responsible for providing direct patient care and coordination of overall home care services. This role requires a strong clinical background, excellent communication skills, and the ability to work independently in a fast-paced environment.Key...

  • Medical Assistant

    4 weeks ago


    Lake Oswego, Oregon, United States Kaiser Permanente Full time

    Job SummaryWe are seeking a highly skilled Medical Assistant to join our Neurology team at Kaiser Permanente. As a Medical Assistant, you will play a vital role in delivering high-quality patient care and supporting our clinicians in providing exceptional service to our patients.Key ResponsibilitiesPrepare patients for office visits by collecting and...


  • Lake Oswego, Oregon, United States Miller Full time

    Job DescriptionMiller Work Truck Solutions is seeking a highly motivated and experienced Territory Sales Representative to join our team in the Northwestern region. As a key contributor to our organic growth, you will be responsible for building and strengthening relationships with OEM and local upfitter partners, developing and executing targeted account...


  • Lake Oswego, Oregon, United States City Wide Facility Solutions Full time

    City Wide Facility Solutions (Portland) is seeking a Part-Time Second Shift Services Manager to maintain client satisfaction by checking on our facilities. This role involves coordinating with Account Managers and Independent Contractors to resolve client concerns. The successful candidate will help City Wide, our customers, and Independent Contractors build...

  • Medical Assistant

    4 weeks ago


    Lake Oswego, Oregon, United States Kaiser Permanente Full time

    Job Summary:We are seeking a highly skilled Medical Assistant to join our Cardiology team at Kaiser Permanente. As a Medical Assistant, you will play a vital role in delivering quality patient care and supporting our clinicians in providing exceptional service to our patients.Key Responsibilities:Prepare patients for office visits and procedures by...

  • Medical Assistant

    4 weeks ago


    Lake Oswego, Oregon, United States Kaiser Permanente Full time

    Job SummaryAs a Medical Assistant at Kaiser Permanente, you will play a vital role in delivering high-quality patient care and contributing to a positive care experience. You will work under the supervision of a clinician to provide clinical and administrative support, ensuring that patients receive the best possible care.Key ResponsibilitiesClinical Tasks:...


  • Lake Oswego, Oregon, United States Kaiser Permanente Full time

    Job Summary:The Charge Nurse, under the direct and indirect supervision of the Nursing Unit Coordinator, Assistant Coordinator and/or Hospital Supervisor, facilitates and assists with all levels of nursing care being provided to a group of patients within one nursing unit during the period of one working shift.In addition to these responsibilities, the...


  • Lake Oswego, Oregon, United States Kaiser Permanente Full time

    Job Summary:The Charge Nurse, under the direct and indirect supervision of the Nursing Unit Coordinator, Assistant Coordinator and/or Hospital Supervisor, facilitates and assists with all levels of nursing care being provided to a group of patients within one nursing unit during the period of one working shift. In addition to these responsibilities, the...

  • Medical Assistant

    4 weeks ago


    Lake Oswego, Oregon, United States Kaiser Permanente Full time

    Job SummaryWe are seeking a highly skilled Medical Assistant to join our Primary Care team at Kaiser Permanente. As a Medical Assistant, you will play a vital role in delivering quality patient care and supporting our healthcare team.Key ResponsibilitiesClinical Tasks: Prepare patients for office visits, collect vital signs and medical history, and assist...

  • Gastroenterology LPN

    4 weeks ago


    Lake Oswego, Oregon, United States Kaiser Permanente Full time

    Job SummaryAs a Gastroenterology LPN at Kaiser Permanente, you will play a vital role in delivering high-quality patient care and contributing to a positive care experience and work environment. You will work collaboratively with the healthcare team to provide nursing and administrative support to clinicians and other healthcare team members.Key...

  • Medical Assistant

    4 weeks ago


    Lake Oswego, Oregon, United States Kaiser Permanente Full time

    Job SummaryWe are seeking a highly skilled Medical Assistant to join our Podiatry team at Kaiser Permanente. As a Medical Assistant, you will play a vital role in delivering quality patient care and supporting our healthcare team.Key ResponsibilitiesClinical Tasks: Prepare patients for office visits, collect and document patient data, and assist with...

  • Medical Assistant

    4 weeks ago


    Lake Oswego, Oregon, United States Kaiser Permanente Full time

    Job SummaryAs a Medical Assistant in the OBGYN department at Kaiser Permanente, you will play a vital role in delivering high-quality patient care and supporting our healthcare team. Your clinical and administrative skills will enable you to provide a range of services to patients, from routine check-ups to more complex procedures.Key...


  • Lake Oswego, Oregon, United States Kaiser Permanente Full time

    Job SummaryWe are seeking a skilled Gastroenterology LPN to join our team at Kaiser Permanente. As a Gastroenterology LPN, you will play a vital role in delivering high-quality patient care and supporting our clinicians in providing exceptional healthcare services.Key ResponsibilitiesClinical Tasks: Prepare patients for office visits, perform focused nursing...


  • Lake Oswego, Oregon, United States Gentiva Full time

    About the RoleGentiva Hospice is seeking a compassionate and skilled Registered Nurse to join our team as a Hospice RN. As a member of our interdisciplinary team, you will provide high-quality patient care and support to patients and their families in their homes.Key ResponsibilitiesProvide direct patient care services to hospice patients and supportive care...


  • Lake Oswego, Oregon, United States Kaiser Permanente Full time

    Job Summary:As a Registered Nurse in the Cardiovascular Operating Room at Kaiser Sunnyside Medical Center, you will utilize your clinical judgment skills to diagnose and treat human responses to actual or potential health problems. You will be responsible for assessing, planning, directing, providing, and evaluating nursing care for patients, while...