### Who We Are
We are an equal opportunity employer dedicated to building a diverse and inclusive workforce. Our mission focuses on incorporating an equity lens into all aspects of our work, striving to reduce health disparities, fostering anti-racism, and cultivating an equitable workplace environment.
### About the Role
The position involves overseeing clinical medical necessity reviews related to prior authorization and care coordination for members. It is essential to facilitate processes and workflows with internal teams, facilities, and vendors, ensuring timely completion of requests.
### Key Responsibilities

• Manage daily operations of Behavioral Health Utilization Management (BH UM), ensuring effective volume management, staffing, regulatory compliance, and quality oversight.
• Develop and implement policies and procedures aimed at streamlining the BH UM functions while ensuring compliance with NCQA, federal, and state regulations.
• Lead and mentor a team, providing guidance on both clinical and operational issues, and supporting professional staff development.
• Conduct analyses and generate reports to measure operational efficiency and track progress toward established goals.
• Participate in quality audits, review medical records, address complex cases, and ensure high standards of care are maintained.
• Collaborate with stakeholders to implement clinical tools that enhance process standardization and improve data collection.

### Qualifications

• An active Licensed Registered Nurse (RN) or licensed Master's Level Social Worker (LCSW, LMSW, LMSW-ACP, CSW, LPC, LMFT, LMHC) in the State of Washington, without any restrictions.
• Preferred: Bachelor's degree in nursing (BSN).
• A minimum of three years of clinical experience in behavioral health, ideally in acute care, skilled nursing, or rehabilitation settings.
• At least two years of leadership experience in Utilization Management.
• Familiarity with assessment tools such as CA/LOCUS, ASAM, CANS, and GAIN is preferred.

### Skills and Abilities

• Strong leadership, communication, and interpersonal skills.
• Proficient in setting and monitoring quality and productivity goals to drive continuous improvement.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook) and clinical criteria sets like Milliman and InterQual.
• Comprehensive understanding of adult and child behavioral health systems of care and evidence-based practices.

### Additional Requirements

• Successful completion of a criminal background check.
• Compliance with vaccination requirements, allowing for medical or religious exemptions.

### Compensation and Benefits
This position offers a FLSA Exempt status with a competitive compensation package that includes the potential for a 10% annual incentive target based on performance goals. Comprehensive benefits include medical, dental, vision, and a generous employer matching program for the 401(k) retirement plan.
### Physical and Mental Requirements
Responsibilities may include extended periods of sitting, using a computer, and occasional physical tasks such as lifting or bending. Mental requirements entail managing complex tasks, resolving conflicts, and meeting deadlines in a fast-paced environment.
### Work Environment
The role primarily operates in an office setting, with occasional exposure to computer monitor radiation.
Employment Type: Full-Time