Healthcare Utilization Manager

1 week ago


Portland, Oregon, United States Community Health Plan of Washington Full time

We are seeking a highly skilled Healthcare Utilization Manager to join our team at Community Health Plan of Washington. This role plays a vital part in ensuring that our members receive high-quality, cost-effective care.

About the Role

The Healthcare Utilization Manager will be responsible for performing utilization review for medical or behavioral health requests using established clinical guidelines and health plan policies. This includes identifying, coordinating, and implementing high-quality, cost-effective alternatives when appropriate to the patient's condition. The successful candidate will work collaboratively with all members of the healthcare team, patients, families, coworkers, and internal and external customers to achieve optimal patient outcomes.

Responsibilities
  • Conduct review of hospital notifications or prior authorization care requests against established clinical guidelines and health plan policies
  • Collaborate with facilities to perform discharge planning
  • Provide coordination support to members transitioning between care settings or returning home from a hospitalization
  • 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
Benefits

We offer a competitive salary of $83,000 per year, paid bi-weekly, and a comprehensive benefits package including medical, prescription, dental, and vision coverage, flexible spending accounts, and 401(k) retirement plan with employer match. We also provide generous paid time off, holidays, and community service volunteer time.

In addition to a fulfilling career, you will have access to ongoing training and development opportunities to help you grow professionally and personally. Our supportive work environment values diversity, equity, and inclusion, and we strive to create a workplace where everyone feels valued and respected.



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