Clinician

• Guide kidney patients and interdisciplinary teams
• Review medical records
• Coordinate care
• Ensure seamless transitions for patients with chronic kidney disease

Palliative Care Clinician guiding kidney patients at a chronic kidney disease care provider

RN – Palliative Care Clinician

Palliative Care Clinician guiding kidney patients and interdisciplinary teams. Reviewing records, coordinating care, and supporting chronic kidney disease transitions.

• The Level I Utilization Management Clinician performs utilization review for medical or behavioral health requests using utilization review criteria, technologies, and tools.
• Identifies, coordinates, and implements high quality, cost-effective alternatives when appropriate to the patient’s condition.
• Supports 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.
• Ensures members have timely access to care and supports during transitions between levels of care.
• Understands and effectively communicates requirements and follows Community Health Plan of Washington (CHPW) policies and procedures.

Utilization Management Clinician I conducting reviews for medical and behavioral health requests

Behavioral Health Utilization Management Clinician I – RN

Utilization Management Clinician I conducting medical and behavioral health reviews at Community Health Plan of Washington. Collaborating with healthcare team for optimal patient outcomes in a hybrid role.

• Ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or medical policies
• Confirming medical services are appropriate based on assigned benefit plan, medical policies, clinical guidelines, plan benefits, and/or scripted algorithms
• Handling less complex benefit plans and/or contracts
• Conducting and may approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews by assessing clinical information against appropriate medical policies, clinical guidelines, and the relevant benefit plan/contract
• Referring complex or non-routine reviews to more senior nurses and/or Medical Directors

Medical Management Clinician Associate ensuring plan benefits administration and medical necessity assessment

Medical Management Clinician Associate

Medical Management Clinician Associate responsible for benefit plans administration and medical necessity assessments. Requires clinical experience and appropriate licensure for virtual healthcare role.

• Behavioral Health Clinicians provide assessments and ongoing individual counseling for adults, including elders and people with disabilities, in-person in their homes or place of residence, as well as via telehealth.
• Services delivered are strengths-based and include, but are not limited to individual psychotherapy, treatment planning, identification and development of natural supports, advocacy, and collaboration with other supports.
• Clinicians maintain caseloads of approximately 20–25 clients and are expected to meet a minimum billing requirement of 55% of total work hours.
• In addition to weekly individual therapy sessions, clinicians participate in supervision, complete timely documentation, engage in ongoing training, and collaborate with other providers.
• Balancing these responsibilities requires strong organizational skills and thoughtful time management.

Behavioral Health Clinician providing counseling and assessments for NWRC

Behavioral Health Clinician

Behavioral Health Clinician providing counseling and assessments for adults with behavioral health needs at NWRC. Engaging in therapy, coordination, and case management services for community clients.

• 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.

Utilization Management Clinician I performing reviews for medical or behavioral health requests

Utilization Management Clinician I

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

Clinician jobs in Washington

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RN – Palliative Care Clinician

Behavioral Health Utilization Management Clinician I – RN

Medical Management Clinician Associate

Behavioral Health Clinician

Utilization Management Clinician I