Lead Utilization Management Coordinator (SALEM) at Greater Oregon Behavioral Health

Salem, Oregon, United States -

Full Time

Start Date

Immediate

Expiry Date

18 Mar, 26

Salary

0.0

Posted On

18 Dec, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Leadership, Utilization Management, Behavioral Health, Clinical Review, Documentation, Quality Assurance, Data Analysis, Policy Development, Collaboration, Communication, Critical Thinking, Training, Mentorship, Compliance, Workflow Management, Culturally Responsive

Industry

Mental Health Care

Description

Description The Lead UM Coordinator is a senior-level role responsible for providing advanced coordination, leadership, and expertise within GOBHI’s Behavioral Health Utilization Management (UM) program supporting the Eastern Oregon Coordinated Care Organization (EOCCO). This position leads and mentors UM team members, oversees complex UM workflows, and ensures compliance with Oregon Administrative Rules (OARs), Oregon Health Plan (OHP) requirements, and EOCCO contract standards. This position takes a lead role in assuring utilization management business efforts for operations, compliance and quality improvement. This person works closely with claims, appeals, and compliance teams. This role requires clinical licensure and strong behavioral health knowledge to assist in evaluating documentation, supporting medical necessity reviews, and guiding team members through complex clinical and administrative scenarios. The Lead Coordinator collaborates closely with licensed clinical reviewers and internal and external partners to support timely, accurate, and person-centered UM processes. This position carries a case load for utilization management. This position reviews authorizations for medical necessity and/or medically appropriate services of behavioral health treatment for members. This is for utilization for the Oregon Health Plan benefits that are tied to EOCCO. Core job tasks include clinical review of requests for services against medical necessity criteria, informing requesting providers of results of reviews, and participating in internal and external multidisciplinary team meetings. Requirements Leadership & Team Support Provide daily leadership, mentorship, and technical guidance to UM Coordinator team members. Serve as the primary resource for complex questions, workflow clarification, and elevated case scenarios. Assist with onboarding, training, and ongoing staff development to promote high-quality, consistent UM practices. Support assignment of workflow tasks, workload balancing, and coverage planning across the UM team. Offer performance-related feedback to the Clinical Services Director, identifying trends, strengths, and training needs. Model trauma-informed, culturally responsive, and person-centered standards consistent with GOBHI and EOCCO values. Utilization Management Expertise Support and coordinate behavioral health authorization processes for multiple levels of care. Apply advanced clinical knowledge to evaluate documentation quality and assist in determining alignment with medical necessity criteria. Collaborate with licensed clinical reviewers (LPC, LCSW, LMFT, psychiatrist, or PMHNP) on complex UM cases and authorization decisions. Ensure UM operations meet all regulatory requirements, including OAR timelines, OHP benefits, EOCCO policy standards, and CMS expectations. Maintain accurate and timely documentation within designated UM systems. Quality & Process Improvement Participate in quality assurance activities, including file audits and review of staff accuracy and workflow adherence. Support the development and updating of UM policies, procedures, desk guides, and training materials. Identify workflow gaps and recommend improvements to enhance efficiency and regulatory compliance. Assist in utilization reporting, data analysis, and OHA readiness review preparation. Researches, interprets, revises and creates policies and procedures related to UM business operation practices. Maintains current knowledge of latest state laws, OAR's and contracts to meet compliance. Provider, Partner, and Cross-Department Collaboration Serve as an advanced resource for EOCCO providers regarding UM processes, required documentation, and authorization standards. Collaborate with GOBHI departments including Care Coordination, Provider Relations, Quality Improvement, Appeals/Grievances, and others. Address provider escalations and complex inquiries with professionalism, clarity, and solutions-focused communication. Support internal partners by sharing UM insights and contributing to collaborative member-centered care planning. Minimum Qualifications Master’s degree in social work, counseling, psychology, behavioral health, or closely related field required. Active Oregon clinical licensure required: LPC, LCSW, or LMFT (must be current and in good standing). Five years of experience in behavioral health utilization management review at a coordinated care organization Experience providing leadership, guidance, or mentorship to staff. Strong knowledge of Oregon Medicaid, OHP benefits, OAR requirements, CCO contractual timelines and behavioral health clinical practices. Familiarity with InterQual, ASAM, DSM-5, and managed care UM guidelines. Excellent critical-thinking skills and the ability to interpret clinical information within UM criteria. Strong communication, organization, and workflow management skills. Ability to work independently in a remote environment and maintain confidentiality and HIPAA standards. Preferred Experience Experience in quality assurance, coaching, or staff training. Knowledge of Oregon’s behavioral health provider system and network operations. Knowledge of rural behavioral health systems and complexities. Work Environment Remote role; must reside in Oregon. Reliable high-speed internet and appropriate home workspace required. Some travel may be required for meetings, training, or staff gatherings.

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Responsibilities

The Lead UM Coordinator oversees complex utilization management workflows and ensures compliance with relevant regulations. They also provide leadership and mentorship to team members while collaborating with clinical reviewers and internal partners.