Utilization Review Specialist
Deschutes County - Bend, OR

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Position is part of the Deschutes County Health Services Quality Management Program. Position is responsible for the implementation of the Utilization Management Plan. Duties include but are not limited to, reviewing internal utilization tools and practices to ensure high quality clinical care; establishing standardized medical necessity; and supporting adherence to applicable state and federal laws. Position will consult with inter-disciplinary staff related to clinical cases and issues (assessment, treatment planning, length of stay, medical justification, diagnosis, transition planning and documentation). Incumbent will assist in developing and implementing utilization related policies and procedures; assist in compliance monitoring and reporting, and will coordinate with regional Coordinated Care Organization, Health Board, panel providers and other community entities. Performs other duties as required.

$4,627.75 - $6,216.60 per month for a 172.67 hour work month, salary normally starts at the first step. Excellent County benefit package when eligible. Position is available immediately.


Minimum Qualifications:
Master's degree in a health or behavioral health field or a PHD, with five (5) years of experience in a community mental health program. Must meet the State of Oregon criteria as a Qualified Mental Health Professional. Licensure preferred.

Working knowledge of psychological, sociological, and psychiatric and integrated care theory; well developed clinical skills and understanding of clinical best practices and evidence-based treatment models that achieve successful outcomes; thorough understanding of pharmacology, psychotropic drugs, and medication management practices and application DSM diagnostic codes; familiarity with Oregon Administrative Rules, the Integrated Services and Supports Rule, Centers for Medicare and Medicaid Services and federal requirements, and other laws and regulations related to utilization review.

Ability to communicate effectively both verbally and in writing; to apply theory in behavioral health and addictions diagnosis and the planning and implementation of intervention programs; to multi-task and manage complex projects; to positively influence groups across the organization to embrace quality clinical practices; to give and welcome constructive feedback; to display sound judgment; to work independently; to prepare and present clear, concise reports; to establish and maintain positive working relationships with other employees; to review documentation for clinical quality and adherence to rules and regulations; to work within a team and collaborate with team members; and to act professionally with regard to a code of ethics and confidentiality.

Necessary Special Requirements:
Possession of or ability to obtain a valid Oregon driver's license within 30 days of hire date. The employment offer will be contingent upon an acceptable and verifiable driver's license and driving history.

Final candidate will be required to provide official proof of college degree and certified transcripts prior to hire date.

Computer literacy with strong typing, data entry, and computer skills required.

Final candidate selected for position will be required to pass a drug screening and a thorough employment and criminal history investigation.