What are the responsibilities and job description for the Utilization Management Specialist position at Jamestown S'Klallam Tribe?
Jamestown Salish Seasons is seeking a Utilization Management Specialist (UMS) to support insurance coordination, utilization management, authorization processes, provider credentialing, and revenue cycle operations within our residential behavioral health program.
This role serves as a key internal resource for insurance and billing operations while supporting continuity of care and program sustainability. The UMS works collaboratively with clinical, operational, and administrative teams to ensure timely authorizations, accurate reimbursement processes, and compliance with regulatory and payor requirements.
The ideal candidate is highly organized, detail-oriented, and experienced in healthcare operations, insurance workflows, and behavioral health environments. This position contributes to a trauma-informed, recovery-oriented, and culturally respectful environment aligned with the mission and values of the Jamestown S'Klallam Tribe.
At JSS, we are committed to providing compassionate, culturally respectful, and recovery-oriented care in a supportive residential setting. Team members play an important role in supporting both resident wellness and organizational sustainability.
Required
Minimum of three (3) years of experience in:
Utilization management
Insurance authorization
Medical billing
Revenue cycle operations
Provider credentialing
Healthcare administration or related healthcare operations
Knowledge Of
Utilization management processes
Insurance authorization requirements
Claims submission and payment posting
Revenue cyc
This role serves as a key internal resource for insurance and billing operations while supporting continuity of care and program sustainability. The UMS works collaboratively with clinical, operational, and administrative teams to ensure timely authorizations, accurate reimbursement processes, and compliance with regulatory and payor requirements.
The ideal candidate is highly organized, detail-oriented, and experienced in healthcare operations, insurance workflows, and behavioral health environments. This position contributes to a trauma-informed, recovery-oriented, and culturally respectful environment aligned with the mission and values of the Jamestown S'Klallam Tribe.
At JSS, we are committed to providing compassionate, culturally respectful, and recovery-oriented care in a supportive residential setting. Team members play an important role in supporting both resident wellness and organizational sustainability.
- Essential Functions
- Serve as an internal resource regarding insurance coverage, authorizations, and utilization management requirements
- Coordinate with Managed Care Organizations (MCOs), commercial insurance companies, and other payors regarding treatment authorizations and continued stay reviews
- Support timely submission of clinical and administrative documentation to maintain authorization compliance
- Assist with denial management activities, including scheduling peer-to-peer reviews and facilitating communication between providers and payors
- Monitor authorization status and communicate updates to appropriate team members
- Coordinate insurance verification, authorization tracking, claims submission, and payment posting within the electronic health record (EHR) system
- Monitor claims, denials, payment variances, and reimbursement trends
- Identify and resolve issues contributing to payment delays, denials, or revenue cycle inefficiencies
- Collaborate with internal teams and external partners to support efficient reimbursement processes
- Ensure billing and documentation processes comply with regulatory, organizational, and payor requirements
- Coordinate provider credentialing, recredentialing, and enrollment activities
- Monitor provider licensure, DEA renewals, and related credentialing requirements
- Maintain accurate credentialing and compliance records
- Train and support staff on insurance, authorization, and billing workflows
- Provide backup support for referral coordination and front desk operations as needed
- Maintain accurate and timely documentation related to insurance and billing coordination
- Participate in meetings, trainings, and quality improvement initiatives
- Communicate professionally with residents, families, payors, and community partners
Required
Minimum of three (3) years of experience in:
Utilization management
Insurance authorization
Medical billing
Revenue cycle operations
Provider credentialing
Healthcare administration or related healthcare operations
Knowledge Of
Utilization management processes
Insurance authorization requirements
Claims submission and payment posting
Revenue cyc