A unique approach to mental health.
Enable extraordinary moments.
SPEC, UTILIZATION MGMT-MH
Mental health is an essential component of total health. As mental health professionals, we’re on the front lines every day, using the latest advances to help those in need. If you share our passion for care and our commitment to helping those around us, you’ll have the resources you need to make a real difference. Our services include adult and child therapy as well as help with addiction and eating disorders.
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Job Type:Standard
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Job Level:Individual Contributor
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Travel:Yes, 5 % of the Time
Success Profile
These are the traits of the most successful members of our behavioral health team.
- Adaptable
- Compassionate
- Good listener
- Proactive
- Results Driven
- Versatile
Benefits
Our compensation and benefits are designed to help you and your family stay healthy and thrive in and beyond work.
Our Culture
We offer a mental health environment that's unique both in the way we treat our patients and in the way we support our health care professionals. Here, we practice evidence-based care in a team setting that’s focused on the needs of the individual, the family and the population as a whole. This gives your patients the opportunity to work towards achieving their physical, mental, and behavioral health goals. On our teams, we hold social justice as a shared value and are committed to addressing and eliminating stigma associated with mental health and addiction. Working as part of a team also helps support your own career growth while you provide high-quality strengths-based, brief, solution-focused, and episodic mental health care.
Hear From Our People
Aaron
Psychiatric Social Worker
Kaiser Permanente has been an excellent platform for me to grow as a professional. The organization has demonstrated its commitment to the continued growth of its employees through the training it offers and encourages. I’ve always resonated with the organization’s integrated approach to health care, and its recognition of how essential good mental health is to a person’s overall well-being.
Breeza
Licensed Certified Social Worker
I would recommend and do recommend workingfor Kaiser Permanente. It’s a professional, clean,friendly, fast-paced environment and there is a real trustand respect for clinical staff no matter what role weserve. I love feeling valued and heard and am thankful tohave found an environment that providesthat.
Janice
Licensed Marriage & Family Therapist
This is the best place to work because ofthe commitment to the total health of our members, thework/life balance, the possibilities to use clinical skillsin a variety of capacities within the organization andopportunities for personal and professional growth. Asemployees of Kaiser Permanente, we all have a voice and areencouraged to use it.
Gabriela
Clinical Program Manager
At Kaiser Permanente, I have opportunities to learn and work in a professional setting with people who are passionate about patient care. I love my career as a therapist and now as a manager! I really enjoy helping others and learning new interventions and modalities. These ensure my personal and professional growth.
Laura
Psychotherapist
Kaiser Permanente is a health care leader who sets trends and makes a difference in industry practices and protocols. I like the extraordinary resources available to do my job, the servant leadership of my manager and director, and the high standard of business and clinical ethics.
Amie
PsyD, Clinical Psychologist
We’re an innovative, vision-forwardcompany. While Integrative-Care models are relatively new,we’ve been on the frontlines of building out ahigh-functioning integrated team for over a decade. Withinthis model of care, we’re pushed to think out of the boxwhen it comes to patient care, be collaborative, andsucceed in a fast-paced environment.
Carol
PhD, Licensed Certified Social Worker – Clinical
Kaiser Permanente demonstrates itscommitment to their employees’, has a top-notch salary andcompensation package, and has a leadership body that iswell trained and supportive. As a Clinician and a Manager,I am very impressed with our commitment to qualityoutcomes. I have truly found a home here and would behonored for Kaiser Permanente to be my last professionalstop in my career.
Michael
PsyD, Licensed Marriage and Family Therapist, Psych Social Worker
Kaiser Permanente, in my opinion, is agreat mix of professional, friendly and fast-paced. Theyallow me to be who I am and let me have a voice. I lovebeing a therapist and I’m very proud and excited about theGender Assessments and transgender group work beingconducted. I’m helping the LGBT community and making thispopulation feel comfortable throughout their care journey.Kaiser Permanente is a breath of fresh air to me in mywork.
Kashonda
Psychotherapist
I appreciate how Kaiser Permanente strivesto reflect inclusivity and representation throughout theorganization. I’m excited about an internal cliniccomprised of African American clinicians dedicated tosupporting the health needs of the African diaspora. I’mproud to be part of committees that intentionally promoteequity, inclusion and diversity. These things combined withthe benefits, opportunities and people make KaiserPermanente a great place to work.
SPEC, UTILIZATION MGMT-MH
Ensure consistent application and management of Kaiser Permanente mental health and chemical dependency benefits.
- Benefit payment authorizations. Manage behavioral health benefits by providing medical necessity determinations. Medical necessity determinations are completed by gathering the most current clinical information from the assessing/treating provider and applying the approved Kaiser Permanente medical necessity criteria to determine what can be authorized within the benefit provisions. Medical necessity criteria are used for all pre-authorization, concurrent review and post-service requests. Authorizations must be for the most clinically appropriate, least restrictive, most cost effective and within standards of care to safely treat the member.
- Member contact. Member contact may occur for a variety of reasons which can include benefit explanations, resource identification and appointment scheduling.
- Payment denials. Kaiser policies are followed for all benefit payment denials. UM coordinator is always available to explain a payment denial to providers and members.
- Consultations. Consultations are provided to internal and external providers regarding medical necessity interpretation, benefits, covered services, contracted providers and available resources that meet the clinical needs of the Kaiser member.
- Fraud and abuse. Responsibility for ensuring the appropriate expenditure of healthcare dollars in accordance with rules and regulations set forth in Kaiser policies, licensing and credentialing entities and all state and federal laws and regulations.
- Ensuring continuity of care by facilitating communication between service providers regarding treatment planning, intervention, outcomes, and recommendations.
- Care coordination. Ensuring upon discharge from higher levels of care that all members have an appropriate discharge plan within HEIDIS guidelines.
- On-call rotation as assigned to cover pre-authorizations for non-business hours.
- Minimum three (3) years of experience working directly or indirectly with individuals with mental health or chemical dependency conditions, which would include diagnosing, treating or managing.
- Minimum two (2) years of experience in utilization management and discharge planning.
- Masters degree in mental health, social work or closely related field from an accredited institution.
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- Understanding of medical necessity criteria and its application.
- Knowledge of DSM-IV diagnoses, community standards of treatment and treatment interventions for mental health, addictions and co-occurring disorders.
- Familiarity with community resources.
- Knowledge of how behavioral health benefits work.
- Good clinical judgment in assessing the clinical needs of patients and matching those needs to the appropriate level of care.
- Demonstrated ability to develop successful interpersonal relationships and earn the respect of physicians, nurses, therapists and other personnel.
- Able to participate as a team member, but demonstrates high level of self-motivation and ability to work independently.
- Excellent oral and written communication skills.
- Excellent problem solving abilities, detail oriented, and very organized.
- Use medical criteria for UM decision-making and education with patients, providers, and community providers.
- Ability to effectively utilize computerized medical records.
- Ability to use Microsoft Office software.
- Ability to use analytical software.
- Ability to collect, analyze, and report statistically meaningful quality and utilization data.
- Excellent written and verbal communication skills; presentation skills; analytical problem-solving skills; well developed project management skills; and competent quantitative skills.
- Minimum five (5) years of experience working directly or indirectly with individuals with mental health or chemical dependency conditions, which would include diagnosing, treating or managing.
- Current, unrestricted license/certificate in state where job is assigned:
- Oregon Licensed Clinical Social Worker (LCSW) or Licensed Marriage and Family Therapist (LMFT) or Licensed Professional Counselor (LPC) or Licensed Psychologist (PhD or PsyD) or Certified Alcohol and Drug Counselor (CADC).
- Washington Licensed Independent Clinical Social Worker (LICSW) or Licensed Advanced Social Worker (LASW) or Licensed Marriage and Family Therapist (LMFT) or Licensed Mental Health Counselor (LMHC) or Licensed Psychologist (PhD or PsyD) or Chemical Dependency Professional (CDP).
- Understanding of Milliman Criteria, ASAM Criteria, and both Kaiser and community UM processes and procedures.
- Knowledge of Kaiser Permanente resources, Behavioral Health system and benefits.
- Understanding of insurance operations and applying benefits.
- Ability to apply medical necessity criteria solely on clinical relevance and not basing decisions on financial outcomes.
- Demonstrated ability to work with providers within contractual relationships and develop positive working relationships.
- Ability to issue and explain adverse benefit determinations.
Navigating the Hiring Process
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Industry Leader
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Careers in Mental Health
Join a team that helps empower our members to achieve all of their physical, mental, and behavioral health goals. Learn more about our culture, programs, and opportunities.
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Mental Health Training Programs
Comprehensive programs where more than 200 mental health trainees can work and learn in communities across Northern California.
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Mental Health and Wellness
A growing collection of resources where patients and caregivers alike can find answers to the many common mental health questions.
Mental Health at Kaiser Permanente
Our collaborative team of caregivers is each focused on using the latest advances and our own skills to improve outcomes for our members and advance our collective understanding of mental health.
Our Events
Want to talk to a member of the Kaiser Permanente team? Meet us at an upcoming hiring event.
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