Kaiser Permanente is Hiring a Remote Specialist, Utilization Management-Mental Health (Remote - Must live in Oregon)

Qualifications:

• 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.

• Masters degree in mental health, social work or closely related field from an accredited institution.

• N/A

• 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.

• 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.

Job Summary