Utilization Management Clinician I

Community Health Plan of Washington

Utilization Management Clinician I at Community Health Plan of Washington performing reviews of health requests with a focus on patient outcomes and care coordination.

Posted 6/30/2026full-timeRemote • Washington • 🇺🇸 United StatesJuniorMid-Level💰 $36 - $56 per hourWebsite

About the role

Key responsibilities & impact

Perform utilization review for medical or behavioral health requests using utilization review criteria, technologies, and tools.
Identify, coordinate, and implement high quality, cost-effective alternatives when appropriate to the patient’s condition.
Support physician decision-making, working collaboratively with all members of the health care team, the patient, the patient’s family, co-workers, and internal and external customers to achieve optimal patient outcomes.
Ensure members have timely access to care and supports during transitions between levels of care.
Conduct review of hospital notification or prior authorization care requests against established clinical guidelines and health plan policies.
Conduct onsite visits to local facilities 1-3 times weekly to connect with members and support successful post-discharge transitions.
Collaborate with facilities to perform discharge planning.
Provide coordination support to members transitioning between care settings or returning home from a hospitalization.
Identify member needs and provide support to ensure necessary services are available during the transition period.
Collaborate with providers, office staff, and Care Coordination team to assure coordination of care in a timely manner according to contractual and regulatory timeframes.
Identify, coordinate, and ensure high quality care and appropriate care by focusing on supporting access to care and services across the continuum of care in accordance with the patient’s medical needs.

Requirements

What you’ll need

Have a bachelor’s degree in a relevant field or an equivalent combination of education and highly relevant experience.
Have a current, unrestricted license as an RN or LPN.
Have at least two years clinical experience in either a physical health or behavioral health setting.
Have previous experience in Utilization Management and Managed Care, preferred.
Effective written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers.
Ability to multi-task and deal with complex assignments with competing priorities on a frequent basis.
Experience in care management workflow systems.
Demonstrated organizational, time management, and project management skills.
Demonstrated proficiency and experience with Microsoft Office products.

Benefits

Comp & perks

Medical, Prescription, Dental, and Vision
Telehealth app
Flexible Spending Accounts, Health Savings Accounts
Basic Life AD&D, Short and Long-Term Disability
Voluntary Life, Critical Care, and Long-Term Care Insurance
401(k) Retirement and generous employer match
Employee Assistance Program and Mental Fitness app
Financial Coaching, Identity Theft Protection
Time off including PTO accrual starting at 17 days per year
40 hours Community Service volunteer time
10 standard holidays, 2 floating holidays
Compassion time off, jury duty

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Utilization ManagementClinical Guidelines ReviewCare Management Workflow SystemsBehavioral Health ExperiencePhysical Health Experience

Soft Skills

Organizational SkillsTime ManagementMulti-taskingCollaboration

Certifications

RN LicenseLPN License