Central City Concern (CCC) is an innovative nonprofit agency providing comprehensive services to single adults and families impacted by homelessness, poverty, and addictions in the Portland metro area. We hire skilled and passionate people to meet our mission to end homelessness through innovative outcome-based strategies that support personal and community transformation.
CCC is seeking a Utilization Review and Management Specialist to join our team!
The Utilization Review and Management Specialist are responsible for leading CCC’s utilization review and management activities in Mental Behavioral Health Services. This role partners closely with Health Services leadership, the Office of Integration and Innovation, the Finance department, and other vital functions to ensure client-centered, trauma-informed, and compliant level of care placement, transitions of care, and ongoing utilization review and management.
- Design, implement, manage, and continuously improve a mental behavioral health utilization review and management program, including:
- Perform routine admissions reviews to monitor the appropriate initial placement of clients;
- Identify opportunities for the level of care placement reviews;
- Complete level of care placement reviews; and
- Collaborate with clinical care teams and clients to plan and execute level-of-care placement changes within CCC and to external providers.
- Provide training and consultation to admissions specialists to ensure initial placement of clients at levels of care that adhere to medical necessity criteria, regulatory requirements, and insurance rules.
- Provide training and consultation to clinical care teams to support adherence to medical necessity criteria, regulatory requirements, and insurance rules.
- Collaborate with clinical care teams, leadership, and medical billing partners on issues related to the level of care placement and care transitions.
- Partner with the Office of Integration and Innovation to design, implement, and continuously improve mental behavioral health care pathways.
- Develop and maintain relationships with community partners, including providers and payers, related to mental behavioral health services access, level of care placement, and care transitions.
- Work within the scope of training and experience, and seek consultation when appropriate.
- Adhere to all state and federal privacy regulations, including HIPAA and 42 CFR Part 2, and CCC policies and agreements regarding confidentiality, privacy, and security. Support compliance with all privacy and security requirements pursuant to community partners' and outside providers’ patient confidentiality agreements, including privacy and security requirements for EMR access. This includes immediately reporting any breach of protected health information or personal identifying information of any person receiving CCC services by CCC or an outside provider to the CCC Compliance Department, as well as to your supervisor or their designee.
- Provide the highest standard of customer service to internal and external stakeholders, including CCC clients, CCC staff, and community members.
- Attend all mandatory CCC training promptly.
- Other duties as assigned.
- Bachelor's of Nursing (BSN) required.
- Current Oregon RN license.
- Must be able to document nursing interventions and responses to care. Do so in an accurate, legible, and intelligible manner.
- Has the competencies necessary to:
- Identify precipitating events;
- Gather histories of mental, emotional, and physical disabilities, alcohol and drug use, past mental health services, and criminal justice contacts;
- Assess family, social, and work relationships
- Conduct a mental status assessment
- Document a multiaxial DSM diagnosis
- Write and implement or supervise the implementation of a treatment plan
- Conduct and document a mental health assessment
- Provide mental health treatment and rehabilitative services within one's scope of practice
- Must meet CCC privileging requirements as required by FTCA.
- Must have current CPR/BLS certification prior to starting.
- Strongly preferred: experience working with an under-served adult population experiencing mental illness, substance abuse, and/or houselessness.
- Intermediate computer skills and high proficiency in Microsoft Office Suite are required.
- Must have a high tolerance for ambiguity and change.
- Physical ability to bend, stoop, kneel, squat, twist, reach, pull, and occasionally lift 25 lb.
- Must possess a current driver’s license, pass a DMV background check, and be designated an “acceptable” driver as outlined in Central City Concern’s Fleet Safety Policy. Must pass an initial driver's training within 60 days of being an approved driver and continued recertification training.
- Adhering to Central City Concern’s drug-free workplace encourages a safe, healthy, and productive work environment and strictly complies with the Drug-Free Work Place Ace of 1988.?An employee shall not, in the workplace, unlawfully manufacture, distribute, dispense, possess or use a controlled substance or alcohol.
- Must pass a pre-employment drug screen, TB test, and background check. This includes clearance by the DHS Background Check Unit.
- Must adhere to agency’s non-discrimination policies.
- Ability to effectively interact with co-workers and clients with diverse ethnic backgrounds, religious views, political affiliations, cultural backgrounds, lifestyles, and sexual orientations and treat everyone with respect and dignity.
Central City Concern offers an incredible benefits package to our employees!
- Generous paid time off plan beginning at 4 weeks per year at the time of hire. Accrual increases with longevity.
- Amazing 403(b) Retirement Savings plan with an employer match of 4.25% in your 1styear, 6% in the 2nd year, and 8% in your 3rd year!
- 11 paid Holidays PLUS 2 Personal Holidays to be used at the employee’s discretion.
- Comprehensive Medical, Vision, and Dental insurance coverage.
- Employer Paid Life, Short-Term Disability, AND Long-Term Disability Insurance!
- Sabbatical Program offers extended time off in years 7, 14, and 21.
This description is intended to provide a snapshot of the work performed. It is not designed to contain a comprehensive inventory of all duties, responsibilities, and qualifications required for the position.
Central City Concern is a second-chance employer and complies with applicable laws regarding considering criminal background for employment purposes. Government regulations, contractual requirements, or the duties of this particular job may require CCC to conduct a background check and take appropriate action to address prior criminal convictions.?