Utilization Management Clinician I

Our commitment is to

Strive to apply an equity lens to all our work. Reduce health disparities. Create an equitable work environment.

About the Role

The Level I Utilization Management Clinician performs utilization review for medical or behavioral health requests using utilization review criteria, technologies, and tools. Identifies, coordinates, and implements high quality, cost-effective alternatives when appropriate to the patient’s condition. Supports physician decision-making, working collaboratively with all members of the health care team, the patient, the patient’s family, co-workers, and internal and external customers to achieve optimal patient outcomes.

Ensures members have timely access to care and supports during transitions between levels of care. Understands and effectively communicates requirements and follows Community Health Plan of Washington (CHPW) policies and procedures.

To be successful in this role, you

Have a bachelor’s degree in a relevant field or an equivalent combination of education and highly relevant experience. Have a current, unrestricted license as an RN or LPN. Have at least two years clinical experience in either a physical health or behavioral health setting. Have previous experience in Utilization Management and Managed Care, preferred.

Essential functions and

Roles and Responsibilities

Conduct review of hospital notification or prior authorization care requests against established clinical guidelines and h