Specialist, Utilization Management-Mental Health (Remote - Must live in Oregon)
Portland, OregonMental health is an essential component of total health. As mental health professionals, we’re on the front lines every day, using the latest advances to help those in need. If you share our passion for care and our commitment to helping those around us, you’ll have the resources you need to make a real difference. Our services include adult and child therapy as well as help with addiction and eating disorders.
- Job Type: Call-in/On-Call
- Job Level: Individual Contributor
- Travel: Yes, 5 % of the Time
Success Profile
These are the traits of the most successful members of our behavioral health team.
- Adaptable
- Compassionate
- Good listener
- Proactive
- Results driven
- Versatile
Benefits
Our compensation and benefits are designed to help you and your family stay healthy and thrive in and beyond work.
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Medical, Vision & Dental
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Professional Development
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Retirement Plans
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Vacation, Holiday & Sick Leave
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Supportive Teams & Resources
NOTE: Benefits may vary based on your Kaiser Permanente region, position, scheduled hours, and representation by collective bargaining or employee groups. *Offerings vary by location.
Our Culture
We offer a mental health environment that's unique both in the way we treat our patients and in the way we support our health care professionals. Here, we practice evidence-based care in a team setting that’s focused on the needs of the individual, the family and the population as a whole. This gives your patients the opportunity to work towards achieving their physical, mental, and behavioral health goals. On our teams, we hold social justice as a shared value and are committed to addressing and eliminating stigma associated with mental health and addiction. Working as part of a team also helps support your own career growth while you provide high-quality strengths-based, brief, solution-focused, and episodic mental health care.
What Our Employees Say
Aaron
Psychiatric Social Worker
“Kaiser Permanente has been an excellent platform for me to grow as a professional. The organization has demonstrated its commitment to the continued growth of its employees through the training it offers and encourages. I’ve always resonated with the organization’s integrated approach to health care, and its recognition of how essential good mental health is to a person’s overall well-being.”
Breeza
Licensed Certified Social Worker
“I would recommend and do recommend working for Kaiser Permanente. It’s a professional, clean, friendly, fast-paced environment and there is a real trust and respect for clinical staff no matter what role we serve. I love feeling valued and heard and am thankful to have found an environment that provides that.”
Janice
Licensed Marriage & Family Therapist
“This is the best place to work because of the commitment to the total health of our members, the work/life balance, the possibilities to use clinical skills in a variety of capacities within the organization and opportunities for personal and professional growth. As employees of Kaiser Permanente, we all have a voice and are encouraged to use it.”
Gabriela
Clinical Program Manager
“At Kaiser Permanente, I have opportunities to learn and work in a professional setting with people who are passionate about patient care. I love my career as a therapist and now as a manager! I really enjoy helping others and learning new interventions and modalities. These ensure my personal and professional growth.”
Laura
Psychotherapist
“Kaiser Permanente is a health care leader who sets trends and makes a difference in industry practices and protocols. I like the extraordinary resources available to do my job, the servant leadership of my manager and director, and the high standard of business and clinical ethics.”
Amie
PsyD, Clinical Psychologist
“We’re an innovative, vision-forward company. While Integrative-Care models are relatively new, we’ve been on the frontlines of building out a high-functioning integrated team for over a decade. Within this model of care, we’re pushed to think out of the box when it comes to patient care, be collaborative, and succeed in a fast-paced environment.”
Carol
PhD, Licensed Certified Social Worker – Clinical
“Kaiser Permanente demonstrates its commitment to their employees’, has a top-notch salary and compensation package, and has a leadership body that is well trained and supportive. As a Clinician and a Manager, I am very impressed with our commitment to quality outcomes. I have truly found a home here and would be honored for Kaiser Permanente to be my last professional stop in my career.”
Michael
PsyD, Licensed Marriage and Family Therapist, Psych Social Worker
“Kaiser Permanente, in my opinion, is a great mix of professional, friendly and fast-paced. They allow me to be who I am and let me have a voice. I love being a therapist and I’m very proud and excited about the Gender Assessments and transgender group work being conducted. I’m helping the LGBT community and making this population feel comfortable throughout their care journey. Kaiser Permanente is a breath of fresh air to me in my work.”
Kashonda
Psychotherapist
“I appreciate how Kaiser Permanente strives to reflect inclusivity and representation throughout the organization. I’m excited about an internal clinic comprised of African American clinicians dedicated to supporting the health needs of the African diaspora. I’m proud to be part of committees that intentionally promote equity, inclusion and diversity. These things combined with the benefits, opportunities and people make Kaiser Permanente a great place to work.”
Specialist, Utilization Management-Mental Health (Remote - Must live in Oregon)
Primary Location Portland, Oregon
Worker Location Remote
Facility East Interstate Medical Offices
Job Number 1263904 Date posted 03/26/2024
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Description:
Ensure consistent application and management of Kaiser Permanente mental health and chemical dependency benefits.
Job Summary:
Ensure consistent application and management of Kaiser Permanente mental health and chemical dependency benefits.
Essential Responsibilities:
- Benefit payment authorizations. Manage behavioral health benefits by providing medical necessity determinations. Medical necessity determinations are completed by gathering the most current clinical information from the assessing/treating provider and applying the approved Kaiser Permanente medical necessity criteria to determine what can be authorized within the benefit provisions. Medical necessity criteria are used for all pre-authorization, concurrent review and post-service requests. Authorizations must be for the most clinically appropriate, least restrictive, most cost effective and within standards of care to safely treat the member.
- Member contact. Member contact may occur for a variety of reasons which can include benefit explanations, resource identification and appointment scheduling.
- Payment denials. Kaiser policies are followed for all benefit payment denials. UM coordinator is always available to explain a payment denial to providers and members.
- Consultations. Consultations are provided to internal and external providers regarding medical necessity interpretation, benefits, covered services, contracted providers and available resources that meet the clinical needs of the Kaiser member.
- Fraud and abuse. Responsibility for ensuring the appropriate expenditure of healthcare dollars in accordance with rules and regulations set forth in Kaiser policies, licensing and credentialing entities and all state and federal laws and regulations.
- Ensuring continuity of care by facilitating communication between service providers regarding treatment planning, intervention, outcomes, and recommendations.
- Care coordination. Ensuring upon discharge from higher levels of care that all members have an appropriate discharge plan within HEIDIS guidelines.
- On-call rotation as assigned to cover pre-authorizations for non-business hours.
Basic Qualifications:
Experience
- Minimum three (3) years of experience working directly or indirectly with individuals with mental health or chemical dependency conditions, which would include diagnosing, treating or managing.
- Minimum two (2) years of experience in utilization management and discharge planning.
Education
- Masters degree in mental health, social work or closely related field from an accredited institution.
License, Certification, Registration
- N/A
Additional Requirements:
- Understanding of medical necessity criteria and its application.
- Knowledge of DSM-IV diagnoses, community standards of treatment and treatment interventions for mental health, addictions and co-occurring disorders.
- Familiarity with community resources.
- Knowledge of how behavioral health benefits work.
- Good clinical judgment in assessing the clinical needs of patients and matching those needs to the appropriate level of care.
- Demonstrated ability to develop successful interpersonal relationships and earn the respect of physicians, nurses, therapists and other personnel.
- Able to participate as a team member, but demonstrates high level of self-motivation and ability to work independently.
- Excellent oral and written communication skills.
- Excellent problem solving abilities, detail oriented, and very organized.
- Use medical criteria for UM decision-making and education with patients, providers, and community providers.
- Ability to effectively utilize computerized medical records.
- Ability to use Microsoft Office software.
- Ability to use analytical software.
- Ability to collect, analyze, and report statistically meaningful quality and utilization data.
- Excellent written and verbal communication skills; presentation skills; analytical problem-solving skills; well developed project management skills; and competent quantitative skills.
Preferred Qualifications:
- Minimum five (5) years of experience working directly or indirectly with individuals with mental health or chemical dependency conditions, which would include diagnosing, treating or managing.
- Current, unrestricted license/certificate in state where job is assigned:
- Oregon Licensed Clinical Social Worker (LCSW) or Licensed Marriage and Family Therapist (LMFT) or Licensed Professional Counselor (LPC) or Licensed Psychologist (PhD or PsyD) or Certified Alcohol and Drug Counselor (CADC).
- Washington Licensed Independent Clinical Social Worker (LICSW) or Licensed Advanced Social Worker (LASW) or Licensed Marriage and Family Therapist (LMFT) or Licensed Mental Health Counselor (LMHC) or Licensed Psychologist (PhD or PsyD) or Chemical Dependency Professional (CDP).
- Understanding of Milliman Criteria, ASAM Criteria, and both Kaiser and community UM processes and procedures.
- Knowledge of Kaiser Permanente resources, Behavioral Health system and benefits.
- Understanding of insurance operations and applying benefits.
- Ability to apply medical necessity criteria solely on clinical relevance and not basing decisions on financial outcomes.
- Demonstrated ability to work with providers within contractual relationships and develop positive working relationships.
- Ability to issue and explain adverse benefit determinations.
Primary Location: Oregon,Portland,East Interstate Medical Offices
Scheduled Weekly Hours: 1
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Call-in/On-Call
Job Type: Standard
Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: NUE-NW-01|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Interstate - East Medical Ofcs - Mental Health/Resource-Admin - 1008
Pay Range: $43.55 - $56.32 / year
The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: Yes, 5 % of the Time
Remote: Work location is the remote workplace (from home) within KP authorized states.
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
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