Remote Utilization Review Nurse Jobs in Renton, WA

This position is remote. However, the candidate will need to reside in Washington State in order to travel to local hospitals. 

Who we are

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

• Strive to apply an equity lens to all our work. 
• Reduce health disparities. 
• Create an equitable work environment. 

About the Role

The Civil Commitment/State Hospital Liaison position is responsible for providing services to Community Health Plan of Washington (CHPW) members transitioning to and from State Hospitals and Long Term Civilly Committed (LTCC) behavioral health (BH) beds, and other inpatient psychiatric facilities. The Liaison will facilitate intake, evaluation, and referral services for members in behavioral health settings. The Liaison will help manage the State Hospital and LTCC population, such that it aligns with the target census set by Washington State Health Care Authority and Behavioral Health Administration.

To be successful in this role, you:

• Have either a Master’s degree in Social Work, Psychology, Behavioral Health, a Social Service field or a related field. Or have a Nursing degree, or an equivalent combination of education and highly relevant experience required. Have a current, unrestricted clinical license in the State of Washington as an RN, ARNP, Social Worker, Psychologist, etc.
• Have five (5) years of experience in the mental health field, required.
• Have three (3) years of experience working for a Managed Care Organization, Regional Support Network, or Behavioral Health Organization, required.
• Have three (3) years of experience working in the Substance Use Disorder treatment field, preferred.
• Have experience with care management workflow systems, utilization and operations data, preferred.
• Have a Chemical Dependency Professional certificate, preferred.

Essential functions and Roles and Responsibilities:

• Provide services as outlined in the ESH-CHPW agreement, WSH-CHPW agreement, CHPW policies, and the IMC Wrap-Around Contract.
• Travel to and meet with members hospitalized at the State Hospitals, LTCC and civilly committed to community hospitals for assessment, treatment planning, diversion, and discharge planning.
• Work collaboratively with family members, advocacy groups, and other stakeholders to support member care, recovery, and community reintegration.
• Work collaboratively with community hospital and State Hospital staff in supportive of effective and efficient treatment for CHPW members.
• Attend all regional liaison meetings (as applicable), and treatment team meetings and other hospital meetings relevant to CHPW members.
• Facilitate communication and care coordination among CHPW staff, including utilization management and care management, relating to care of civilly committed members.
• Provide training and consultation to CHPW staff and community stakeholders.
• Review requests for Behavioral Health Wraparound Care (BHWC).
• Review requests and create authorizations (when applicable) for Community Based Health Support (CBHS).
• Review request and create authorization or denial episodes for Intensive Behavioral Supportive Supervision (IBSS).
• Exempt – Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Knowledge, Skills, and Abilities:

• Working knowledge of both Western and Eastern Liaison processes
• Working knowledge of effective Care Management and Care Coordination practices.
• Working knowledge of Managed Care Organizations including Utilization Management, Care Management, Care Coordination, and Transitions of Care.
• Knowledge of DSM, effective psychosocial treatments for serious and persistent mental illness, psychiatric medication positive and negative effects, Washington State behavioral health system of care, and community resources
• Ability to work independently.
• Excellent computer skills including knowledge of electronic health records, Microsoft Office products, data-base utilization, and networking.
• Effective verbal and written communication skills
• Effective organizational, time management, and project management skills.
• Ability to communicate with and collaborate effectively with physicians and allied health care providers.
• Ability to present in a group setting.
• Demonstrate professional courtesy to others and ability to maintain confidentiality.

Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn’t perfectly check every box in the job description, we encourage you to apply anyway.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check.

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Exempt and is not eligible for overtime and has a 10% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate’s job-related knowledge, skills, and experience among other factors. 

CHPW offers the following benefits for Full and Part-time employees and their dependents: 

•  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

Sensory/Physical/Mental Requirements:

Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking and possibly standing
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
• Frequent torso/back static position; occasional stooping, bending, and twisting.
• Some kneeling, pushing, pulling, lifting, and carrying (not over 25 pounds), twisting, and reaching.

Mental:

• Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.