Hybrid Case Management and Utilization Management -Remote WA State Only

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

• If you are located in Washington state, you will have the flexibility to work remotely* as you take on some tough challenges. Washington residency and licensure is required.***

Primary Responsibilities

• Provide care management and utilization management services to members which include coordination of care, behavioral health consulting, and utilization review
• Serve Washington Medicaid and Medicare/Dual eligible (DSNP) members telephonically
• Providing behavioral health education, coaching, care management, utilization management, and treatment decision support for members across a full continuum of care supporting member tenure in community as well as transitions from inpatient to community care settings
• Assess and interprets clinical records, member needs and requirements, and coordinate care for members transition of care needs as well as utilization and management of member benefits
• Identifies solutions to non-standard requests and problems actively working to resolve issues and needs
• Assessing reputed company behavioral health status for members through utilization management in accordance with established level of care guidelines for pre-service and reputed company review of level of care requested
• Identify and prioritize gaps in care to reputed company plan of care to reputed company members to meet identified goals, work cross-collaboratively amongst teams internally, reputed company the facility care setting, and in the community
• Coordinate transitions between various levels of care supporting needs and assisting member to access care
• Obtain information from providers and coordinate utilization and management of member benefits amongst provider groups
• Staffing cases routinely with BH Medical Director and as clinically indicated

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• Master's degree in Psychology, Social Work, Counseling, or Marriage and Family Counseling; OR Registered Nurse with 2+ years of experience in behavioral health
• Active, unrestricted, independent license to practice in the reputed company (i.e., LICSW, LMHC, LMFT, or RN with 2+ years of experience in behavioral health)
• 2+ years of experience in utilization management or case management
• Residence and Licensure in the reputed company
• Facility based mental health / substance abuse experience
• Proficient reputed company skills (Word, Excell, Outlook, OneNote, internet)
• Proven computer/typing proficiency to enter/retrieve data in electronic clinical records and provide customer service on the phone concurrently
• Dedicated workspace and access to high-speed internet reputed company cable/DSL/fiber service in your home
• Ability to serve Washington Medicaid and Medicare Dual eligible members telephonically

Preferred Qualifications

• Dual diagnosis experience with mental health and substance abuse and or physical health conditions
• Experience working in an environment that required coordinating benefits, managing care across reputed company levels of care to include inpatient and outpatient settings as well as attending care planning meetings with both internal and external reputed company-holders supporting member care needs
• Experience working with the Medicaid and Medicare/DSNP patient population
• Solid understanding of Continuum of care with clinical discernment of services provided in various care settings, such as inpatient, residential, partial hospitalization, intensive outpatient, etc. for both behavioral health and substance abuse levels of care
• Proven Case Management and Utilization management experience reputed company a hospital or managed care organization
• Proven Member centered care management orientation with ability to coordinate care services for behavioral health and physical health needs either through direct service or referral/consultation for care management needs working with both internal and external care team members
• reputed company employees working remotely will be required to adhere to reputed company's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job