Behavioral Health Utilization Management Clinician I (Registered Nurse)

Job overview

The Behavioral Health Utilization Management Clinician I (Registered Nurse) role is onsite in Tacoma, WA, with local travel to hospitals in Pierce and Thurston Counties. Compensation is not specified. The role supports Community Health Plan of Washington’s work to reduce health disparities and improve equitable access to care. The clinician reviews medical and behavioral health requests against clinical guidelines and plan policies, coordinates care transitions, and supports timely access to appropriate services. The role contributes to effective utilization review by collaborating with members, providers, facilities, and the care management team, and by preparing cases for medical director review when needed.

What you'll do

• Review hospital notifications and prior authorization requests against clinical guidelines and health plan policies
• collaborate with facilities on discharge planning
• coordinate member transitions between care settings and support access to needed services
• work with providers, office staff, and Care Coordination to meet contractual and regulatory timeframes
• identify potentially unnecessary services and recommend alternatives
• assess out-of-network requests for medical necessity
• verify referrals, enrollment, eligibility, and benefits
• notify patients or families and communicate with the care team
• prepare cases that do not meet criteria for medical director review
• identify candidates for care and disease management programs
• report quality-of-care issues
• travel to local hospitals in Pierce and Thurston Counties.

What we're looking for

Skills & competencies

behavioral health

utilization management

registered nurse

rn

tacoma wa

community health plan of washington

clinical review

care transitions

discharge planning

medical necessity

hospital travel

pierce county

thurston county

Work arrangement

• Weekend coverage required

Benefits & perks

• Medical, prescription, dental, and vision coverage
• telehealth
• flexible spending and health savings accounts
• life and disability coverage
• 401(k) with employer match
• employee assistance program
• paid time off starting at 17 days annually
• 40 hours of community service time
• holidays and other leave.

Why this role

Current unrestricted RN or LPN license required; at least two years of clinical experience required. Utilization Management and Managed Care experience and familiarity with MCG, InterQual, ASAM, or LOCUS are preferred. Eligible for overtime and a 10% annual incentive target; benefits include medical, dental, vision, retirement match, paid time off, and volunteer time.

About the employer

Community Health Plan of Washington is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.