UTILIZATION MANAGEMENT SPECIALIST

Job Description:

UTILIZATION MANAGEMENT SPECIALIST

Description

OVERVIEW

Make a difference in your community. Become a part of the Kitsap County team!
Do what you love while serving the citizens where you live.

About the department:
Kitsap Recovery Center (KRC), located in Port Orchard, provides both inpatient and outpatient substance abuse treatment services.

Annually, approximately 2,000 adult men and women receive chemical dependency treatment for drug and/or alcohol addiction. KRC serves primarily low-income and Medicaid-eligible clients. It also accepts clients with private insurance and provides information, education, and referrals to all county residents.

Summary of position:

We have an exciting opportunity for a Clinical Review Specialist to join our team. The incumbent will perform a wide range of highly complex administrative and clinical review tasks. Responsibilities include the organization, prioritization and coordination of a high volume of confidential information. Duties include providing initial and ongoing utilization review services for clients admitted to KRC. Utilization review functions including acting as a liaison between payors, the business office, and the treatment team, providing information and feedback to assist in optimum patient care and reimbursement. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. The successful candidate will have the exciting opportunity to assist the clinical manager and clinical supervisor, growing our ever-changing program to offer the very best service to the patients we serve.

The ideal candidate will have knowledge of quality management practices, to include continuous quality improvement, knowledge of medical billing and utilization management policies, experience with electronic health records, and an understanding of the physiological, psychological and social/cultural affects of alcohol and drug addiction. The team member should have the ability to proficiently use healthcare and billing applications, the ability to give constructive feedback to employees regarding the proper use of the electronic health records, an understanding of billing, specifically with regards to substance abuse treatment, the ability to collect and analyze data and run statistical reports, and the ability to communicate with insurance companies regarding utilization management and billing issues.

QUALIFICATIONS FOR PERFORMANCE OF THE ESSENTIAL FUNCTIONS

REQUIRED EDUCATION AND EXPERIENCE:

• Associate's degree in a field related to the assigned program area AND
• Three years of professional level workina substance use disorder treatment, mental or behavioral health treatment environment, involving utilization management, orquality assurance OR
• Any combination of related experience and education which provides the applicant with the desired skills, knowledge and ability required to perform the work.

PREFERRED EDUCATION, EXPERIENCE, OR QUALIFICATIONS:

• Substance Use Disorder Professional (SUDP) in good standing with the Washington State Department of Health.
• Experience managing anElectronic Health Record (EHR)program.
• Knowledge of the Washington State Administrative Code (WAC) andFederalregulations regarding inpatient and outpatient substance abuse treatment services.
• Experience providing training to staff.
• Experience with quality management for all audits to ensure compliance with legal and facility standards.

Criminal Conviction Standards:

• The successful incumbent will or may have unsupervised access toa vulnerable adult, or a vulnerable person, or access to a secured/confidential facility or computer system(s). As a result, Kitsap County will be conducting an extensive criminal background check by law enforcement agencies, which may include fingerprinting.
  • Please review the following list of disqualifying crimes and negative actions to determine if you meet our standard for this position: https://www.dshs.wa.gov/ffa/disqualifying-list-crimes-and-negative-actions

Required Licenses, Certificates, Examinations/Tests and Other Requirements

Please note: The incumbent is responsible for obtaining and maintaining all of the following required licenses, certifications and other requirements including continuing education requirements of Washington Administrative Code 246.811.

SUDP Candidates: Prior to employment the successful candidate must:

• Provide a copy of Washington StateSUDP certification ordocumentation of training hours completed and a copy of Washington State Chemical Dependency Professional Trainee (SUDPT) certification.

All Candidates: Prior to employment the successful candidate must:

• Pass a criminal background check through law enforcement agencies.
• Submit official transcripts from an accredited college or university if education is being used to meet the minimum qualifications.
• Declare understanding of and willingness to comply with the requirement that there be no misuse of alcohol or drugs while employed at Kitsap Recovery Center.

All Candidates: Within 30 days after employment the successful candidate must:

• Complete Bloodborne/Airborne Pathogens training and receive Hepatitis B vaccine or sign a waiver
• Complete a Tuberculosis Test (and yearly thereafter)

Working Conditions/Physical Activities
(The physical demands described are representative of those that must be met by the employee to successfully perform the essential functions of this job. Kitsap County provides reasonable accommodation to enable individuals with disabilities to perform the essential functions).

• Work is performed at the Recovery Center, which is a 24-hour, 7 day per week facility.The incumbent may be required to work over 40 hours in a week, and may be exposed to physical hazards while working with hostile clients with a potential for violence.
• Adequate vision is necessary when preparing logs and observing clients.
• Position requires frequent sitting, standing and walking through the work area, occasional pushing/pulling/lifting/carrying up to 25 pounds.
• Speaking/talking on the telephone and in-person is required during frequent contact/communication with the public, patients, program graduates and other departments.
• Some holiday and overtime work may be required.
• 
  Employees in this department are considered 'essential employees' and are expected to report to duty on time and remain at work until the end of the scheduled shift even if an inclement weather event or emergency is declared.
  
  

Incumbents may be:

• Subject to exposure to physical hazards such as: restricted work areas or blood and body fluids requiring the use of safe biohazard and blood borne pathogen prevention methods.
• Exposed to potentially violent or hostile individuals in volatile and dangerous situations within the facility.

ILLUSTRATIVE EXAMPLE OF DUTIES

In this role, you will have the opportunity to:

• Manage the electronic health record (EHR) to include being the point of contact for any concerns that come up related to the system, development and implementation of changes within the facility, and documentation into the electronic health care system.
• Ensure staff are remaining compliant with EHR requirements as well as communicating directly with staff assigned to billing to ensure quality control of billing practices.
• Ensure facility policies and procedures remain compliant with the Washington State Administrative Code (WAC) and federal regulations as well as creating and updating existing policies as necessary.
• Assist in the expansion efforts of KRC including coordination with other county staff, the clinical manager and supervisor and other entities, to continually build on the services and programs offered at KRC.
• Manage the electronic training system utilized for all staff training.
• Provide training to staff including facilitating onboarding, individualized and group trainings on the EHR, policies and procedures for specific positions, and other administrative-related topics.
• Oversee quality management for all staff including record audits to ensure compliance with legal and facility standards.
• Support the clinical manager in establishment and development of contracts with insurance entities and the functions required with the electronic health care record and in staff training for compliance purposes.
• Communicate with insurance companies and other payers regarding utilization management issues.

SUDP Candidates:

• Assist staff with daily operations providing assistance, as necessary, to effectively carry out the mission of KRC within the scope of practice of a chemical dependency professional including: assessments intake, group and individual therapy, coordination of care and case management.
• Process documentation regarding the need for care, including medical necessity for services provided by KRC.

OTHER POSITION RELATED INFORMATION

• Who May Apply: This position is open to the general public. Applications will be screened for qualifications and completion of all the required materials and forms. The most competitive applicants may be contacted for further steps in the selection process, which may include testing for office and computer skills.
• This position is classified as eligible for overtime under the Fair Labor Standards Act (FLSA)
• This position is non-represented and covered under the Kitsap County Personnel Manual. Internal applicants should be aware that a change in union status or bargaining unit may impact your benefits and accruals. Please contact Human Resources if you have questions.
• Kitsap County is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, family or medical care leave, gender identity or expression, genetic information, marital status, medical condition, national origin, physical or mental disability, political affiliation, protected veteran status, race, religion, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable laws, regulations and ordinances. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please contact our Human Resources Office.
• This recruitment is being used to fill an existing open position, and may be used to fill future openings for up to six (6) months.
• Work hours for this position may vary. The Kitsap Recovery Center is a 24 hour facility.

At Kitsap County, we strive to take care of our team! Our employees are the greatest asset of Kitsap County, and we take pride in offering a highly competitive compensation and benefits package to all eligible employees.

County Paid Benefits Include:
Medical - Kaiser Permanente (HMO) or Aetna (PPO)
Dental - Delta Dental or Willamette
Vision - VSP
Flexible Spending Accounts (FSA)
Life Insurance - Basic, Accidental Death and Dismemberment (AD&D), Voluntary Term Life Insurance (VTL)
Disability - Short-term disability & Long-term disability
Voya Voluntary Insurance
Transportation incentives
Employee Assistance Program
Travel Assistance Program
Wellness program
Benefits become effective on the first calendar day of the month following the month in which the employee is hired except if the employee's hire date is the first calendar day of the month, benefits begin on the day of hire. More information about employee benefits is available on the county's website at: https://spf.kitsapgov.com/hr/Pages/Benefits.aspx or the Kitsap County Digital Benefits Guide .

*Voluntary benefit options also available at the employee's expense

Retirement:
Employees are covered under the PERS retirement plan provided through the Washington State Department of Retirement Systems and Social Security.

Deferred Compensation (IRS Plan 457b): tax-deferred savings program

Holidays
11 paid holidays and 2 additional floating holiday per year. One additional floating holiday after 10 years of service.

Vacation Leave
New employees are credited with 48 hours of annual leave upon hire and will be begin accruing at the rate of 8 hours per month starting on their 7th month of employment. Employees may carry over 360 hours from one calendar year to the next. Annual leave accrual will increase upon tenure, as follows:

Upon completion of 2 years: 15 days per year (10.00 hours per month)
Upon completion of 5 years: 20 days per year (13.33 hours per month)
Upon completion of 10 years: 25 days per year (16.67 hours per month)

Sick Leave
All new hires will be credited with 48 hours of sick leave upon hire and will begin accruing at the rate of 8 hours per month starting on their 7th month of employment. Employees may carry over 1200 hours from one calendar year to the next.

***Part-time employees benefit contributions and leave accruals will be prorated***

Current County Employees
If you are transferring or promoting into this position you are responsible for reviewing these benefit changes; prior to accepting a position. In addition, it is your responsibility to notify the Auditor's Payroll Division of a change in union status.

NOTE: This is a general overview of the benefits offered through employment with Kitsap County, and every effort has been made to ensure its accuracy. If any information on this document conflicts or is incorrect with the provisions of the Personnel Manual, applicable laws, policies, rules or official plan documents they will prevail. The Personnel Manual is available at: https://www.kitsapgov.com/hr/Pages/Personnel-Manual-2019.aspx

Closing Date/Time: 5/26/2025 11:59 PM Pacific

Salary:

$33.07 - $42.30 Hourly