NHS Human Services, Inc.

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, visitwww.chpw.org{rel="nofollow"}.

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Manager, Behavioral Health Utilization Management * *This position is available fully remote within Washington State

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[POSITION PURPOSE:]{.underline}

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, as well as the transition of care calls for care coordination. 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.

[PRINCIPAL DUTIES:]{.underline}

• 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.
• 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.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

[QUALIFICATIONS:]{.underline}

[Education]{.underline} & [Prior Related Experience]{.underline}:

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