Manager, Behavioral Health Utilization Management, Seattle, WA
Working Each Day to Make a Difference
At Community Health Plan of Washington, we’re driven by our belief that everyone deserves access to quality health care.
More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.
We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.
- We are a local not-for-profit health plan in Washington State.
- We are committed to keeping Washington families healthy.
- We connect our communities to the health resources they need.
- We provide access to high-quality care for our members.
- We connect and empower our members through technology.
- The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.
- Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system. To learn more about how you can make a difference working at Community Health Plan of Washington, visit www.chpw.org.
Manager, Behavioral Health Utilization Management
The Manager, Behavioral Health (BH) Utilization Management is responsible for the facilitation of BH clinical medical necessity reviews on all member prior authorization and concurrent requests for outpatient services, admissions, and continued stays. The Manager, BH Utilization Management will develop and facilitate processes/workflows with the team, facilities and other vendors to ensure completion of all requests in a timely manner.
- Performs management responsibilities to include but not limited to, involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
- Oversee BH UM daily operations including daily volumes, staffing, regulatory requirements, policy development, program oversight, and quality oversight.
- Review analyses of activities, costs, operation and forecast data to determine progress toward stated goals and objectives. Develop and generate reports to support efficient operations.
- Develop, implement and maintain compliance, policies and procedures regarding behavioral health utilization management functions.
- Ensure compliance with NCQA, federal and state regulations and contractual agreements.
- Establish appropriate staffing levels and work assignments, develop performance criteria for staff and serve as an expert resource on compliance, policies and operational procedures.
- Support the implementation of enhanced clinical tools to achieve standardization in process and data collection, identify areas where efficiencies can be achieved.
- Participate in quality audits, chart audits, and reviews of medical records as needed for either complex high cost cases or cases with quality of care concerns.
- Develop staff skills and competencies through training and experience. Be available to non-clinical staff as a resource for clinical questions.
- Liaison with Regional Office Managers in support of IMC integration and serve as point of contact for Mental Health and Substance Use Providers throughout contracted regions in the state. Identify and resolve issues with internal staff and external stakeholders.
- This position involves traveling on behalf of the Company. It is essential that a current driver’s license, an acceptable driving record, and proof of automobile insurance are maintained.
- Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.
- Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
- Registered Nurse (RN), Licensed Practical Nurse (LPN), or Advance Registered Nurse Practitioner (ARNP), with Behavioral Health experience
- Current unrestricted nursing license
- Master’s degree in Social Work (MSW), Master’s degree in Psychology, Marriage and Family Therapy, or related field required
- Current unrestricted Licensed Mental Health Clinician (LMHC), Licensed Independent Clinical Social Worker (LICSW), or Licensed Marriage and Family therapist (LMFT) required
Prior Related Experience:
- Minimum 3 years’ clinical or case management experience or combination of both required
- Minimum of 3 years’ in a managed care setting preferred
- Minimum of 2 years’ leadership experience in a behavioral health care of managed care setting required
- Minimum of 3 years’ of behavioral health clinical experience required
- Previous behavioral health utilization management plan experience and familiarity with CA/LOCUS, ASAM, CANS, and GAIN preferred
- Minimum of 3 years’ management/supervisory experience with team oversight including management of remote workers preferred
- Experience with care management workflow systems, and utilization and operations data preferred
- Candidate has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
Knowledge, Skills, and Abilities:
- Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion
- Management skills including leading, training and supporting teams
- Ability to set quality and productivity goals, monitor performance and proactively address opportunities for improvement
- Strong interest in participating and leading program design and continuous improvement activities
- Detail oriented problem-solving attitude
- Excellent interpersonal and communication skills and the ability to work in a matrix management environment
- Strong analytic skills with ability to interpret, evaluate and act on productivity, clinical and financial data
- Ability to work in a high performing team environment that requires flexibility
- Proficient computer skills, including Microsoft Office products, Proficiency in MS Excel and enhanced data and statistical analysis skills
- Excellent organizational, time management and project management skills
- Demonstrated ability to handle multiple priorities in a fast paced environment
- Knowledge in criteria set-Milliman and InterQual-preferred
- Experience with NCQA standards and state and federal regulations related to work
- Knowledge of adult and child behavioral health (mental health and substance use) systems of care
- Knowledge of behavioral health evidence based practices
To apply, please visit: http://www.chpw.org/careers/
We're committed to our employees and their family, which is why we offer benefits that, makes a difference in their lives. Paid time off, tuition reimbursement, community service hours, and transportation perks are just a few of the offerings of our comprehensive and competitive benefits program.
Community Health Plan of Washington is an Equal Opportunity Employer with a diverse workforce!
Headquarters: 1111 3rd Avenue, Suite 400 Seattle, WA 98101