Utilization Reviewer Jobs in Portland, OR (NOW HIRING)

Lead Teams. Improve Lives. Drive Meaningful Change.

Are you a passionate healthcare leader who thrives at the intersection of clinical excellence, operational strategy, and patient-centered care?

We are seeking an experienced and compassionate Manager of Care Management to lead the daily operations of our Social Work, Utilization Management, and Access Intake & Referral teams. In this dynamic leadership role, you will oversee programs that support patients with behavioral health needs through care coordination, psychosocial assessments, safety planning, utilization review, and referral management, while ensuring operational excellence, regulatory compliance, and exceptional patient outcomes. The ideal candidate is a collaborative healthcare leader who excels at developing high-performing teams, managing budgets and resources, driving process improvements, and partnering with multidisciplinary stakeholders to advance strategic initiatives and enhance the delivery of patient-centered care.

Unity Center for Behavioral Health is a 24-hour behavioral and mental health services center located in the greater Portland metropolitan area. We provide immediate psychiatric care and a path to stabilization and recovery for individuals experiencing a mental health crisis.  Unity Center offers mental health treatment to adults and adolescents aged 9 to 17.  We also have the only emergency department specifically for behavioral health emergencies in Oregon. The Psychiatric Emergency Services (PES) serves adults 18 and older.  We believe in a trauma informed approach to assessment and treatment.  For more information, please visit our website:  www.unityhealthcenter.org.  

This role manages the day-to-day Care Management operations for a designated hospital and surrounding clinics associated with that hospital's geographic service area.   

Provides administrative leadership for the Care Management team, which is charged with the provision of comprehensive, patient-centered, quality health care for patient populations with acute and chronic health conditions across the continuum. 

Manages and directs Care Management staff, establishing appropriate staffing levels and work assignments, assuring financial/budgetary stewardship and efficient use of resources, and providing appropriate staff development, coaching, and mentoring. 

Integrates with other site leadership to foster seamless transitions of care and optimal patient outcomes across the continuum.

Represents Legacy in the community and works effectively with community-based programs, services, and providers.

Supports Legacy's mission, vision, and values. Creates and/or supports an inspiring department vision. Develops and implements business strategies. Sets specific and realistic objectives and tactics. Knows team strengths, weaknesses, and opportunities for improvement.

Manages Legacy's resources, including productivity and staffing, equipment and supplies, and budgets.

Develops and uses a network of relationships within the organization and the community to achieve system goals.

Collects, analyzes, evaluates and presents clinical management and operations data to a wide range of audiences.

Serves as a resource to all stakeholders regarding regulatory issues.

Guides staff in patient/family discussion of health care goals and decisions with attention to cultural and health literacy implications.

Reviews managed care contracts to ensure that terms and incentives are achievable and reflective of sound Care Management practices/utilization management. 

Develops and implements mechanisms for staff development.

Participates in preparation of site department budget.

Monitors, verifies and reconciles expenditures of budgeted funds identifying cost savings opportunities within operations.

Develops and implements mechanisms for review of high risk/high-cost cases.

Incorporates population and chronic disease management strategies in care planning.

Participates on assigned site and system medical staff committees.

Confronts challenges and problems with an open mind. Uses evidence-based and data-driven approaches. Considers multiple perspectives, probable consequences, and relevant stakeholders. Obtains stakeholder buy-in.

Demonstrates sound fiscal stewardship.  Understands and applies financial management principles.

Facilitates continuous quality improvement by employing Lean principles and analyzing quality indicators, such as clinical outcomes, patient safety measures, and customer satisfaction data.

Engages staff in quality improvement efforts.

Develops comprehensive quality improvement plans. Implements improvements and evaluate success.

Leads change, promotes system-ness and champions new system initiatives and improvements.

Leverages resources and partnerships.

Utilizes systems thinking in networking, negotiating and building cooperative relationships with others across the system and surrounding communities.

Builds and maintains motivated and committed teams.

Communicates clearly, respectfully and professionally.

Pursues professional-development.

Education:  Master of Social Work degree from an accredited School of Social Work required

Experience: 

Minimum of 4 years of behavioral health experience is required. 

One of the 4 years of experience must be related to case management, care coordination and/or community/transitions planning.

Progressive leadership experience required with demonstrated results. 

Basic knowledge of clinical operations, Lean principles/workflow planning, staffing, and scheduling, budget and resource management, data analysis and continuous quality improvement.

Knowledge/Skills: 

Demonstrated knowledge of six core components of case management:

Psychosocial aspects

Healthcare reimbursement

Rehabilitation

Healthcare management and delivery

Principles of practice i.e.  CMS guidelines, medical necessity criteria

Case Management concepts

Excellent organization, oral and written communication skills for effective interaction with staff and other stakeholders.

Demonstrated coaching and staff development skills.

Proficient statistical analytic skills.

Working knowledge of:

Transition planning across the continuum.

Health care reimbursement

Utilization management processes, including medical necessity and CMS guidelines.

Regulatory issues.

Community resources

Able to link care management initiatives to organizational strategic goals and objectives.

Health literate oral and written communication skills as well as public speaking proficiency.

Strong and effective conflict resolution skills.

Keyboard skills and ability to navigate electronic systems applicable to job functions.

Current applicable state (OR and/or WA) licensure required (LCSW).

Our Legacy is good for health for Our People, Our Patients, Our Communities, Our World. Above all, we will do the right thing.

If you are passionate about our mission and believe you can contribute to our team, we encourage you to apply-even if you don't meet every qualification listed. We are committed to fostering an inclusive environment where everyone can grow and succeed.

Legacy Health is an equal opportunity employer and prohibits unlawful discrimination and harassment of any type and affords equal employment opportunities to employees and applicants without regard to race, color, religion or creed, citizenship status, sex, sexual orientation, gender identity, pregnancy, age, national origin, disability status, genetic information, veteran status, or any other characteristic protected by law.

To learn more about our employee benefits click here: www.legacyhealth.org/For-Health-Professionals/careers/benefiting-you