Utilization Management Specialist

Jamestown Salish Seasons is seeking a Utilization Management Specialist (UMS) to support insurance coordination, utilization management, authorization processes, provider credentialing, and revenue cycle operations within our residential behavioral health program.

This role serves as a key internal resource for insurance and billing operations while supporting continuity of care and program sustainability. The UMS works collaboratively with clinical, operational, and administrative teams to ensure timely authorizations, accurate reimbursement processes, and compliance with regulatory and payor requirements.

The ideal candidate is highly organized, detail-oriented, and experienced in healthcare operations, insurance workflows, and behavioral health environments. This position contributes to a trauma-informed, recovery-oriented, and culturally respectful environment aligned with the mission and values of the Jamestown S’Klallam Tribe.

At JSS, we are committed to providing compassionate, culturally respectful, and recovery-oriented care in a supportive residential setting. Team members play an important role in supporting both resident wellness and organizational sustainability.

Schedule:

4x10 Monday - Thursday Essential Functions Utilization Management & Insurance Coordination Serve as an internal resource regarding insurance coverage, authorizations, and utilization management requirements

Coordinate with Managed Care Organizations (MCOs), commercial insurance companies, and other payors regarding treatment authorizations and continued stay reviews

Support timely submission of clinical and administrative documentation to maintain authorization compliance

Assist with denial management activities, including scheduling peer-to-peer reviews and facilitating communication between providers and payors

Monitor authorization status and communicate updates to appropriate team members

Revenue Cycle Support Coordinate insurance verification, authorization tracking, claims submission, and payment posting within the electronic health record (EHR) system

Monitor claims, denials, payment variances, and reimbursement trends

Identify and resolve issues contributing to payment delays, denials, or revenue cycle inefficiencies

Collaborate with internal teams and external partners to support efficient reimbursement processes

Ensure billing and documentation processes comply with regulatory, organizational, and payor requirements

Provider Credentialing & Compliance Coordinate provider credentialing, recredentialing, and enrollment activities

Monitor provider licensure, DEA renewals, and related credentialing requirements

Maintain accurate credentialing and compliance records

Operational Support & Team Collaboration Train and support staff on insurance, authorization, and billing workflows

Provide backup support for referral coordination and front desk operations as needed

Maintain accurate and timely documentation related to insurance and billing coordination

Participate in meetings, trainings, and quality improvement initiatives

Communicate professionally with residents, families, payors, and community partners

Qualifications Required Minimum  of three (3) years of experience in:

Utilization management

Insurance authorization

Medical billing

Revenue cycle operations

Provider credentialing

Healthcare administration or related healthcare operations

Knowledge of:

Utilization management processes

Insurance authorization requirements

Claims submission and payment posting

Revenue cycle operations

Provider credentialing workflows

Proficiency with EHR systems, billing software, payor portals, and standard office technology

Strong organizational, communication, and problem-solving skills

Ability to manage multiple priorities in a fast-paced environment

Understanding of HIPAA, 42 CFR Part 2, and confidentiality requirements

Valid driver’s license

Ability to pass a criminal background investigation

Preferred Qualifications Associate degree in healthcare administration, business, accounting, medical office administration, or related field

Experience working in behavioral health, residential treatment, psychiatric, substance use disorder, or inpatient healthcare settings

Experience with provider credentialing and payor enrollment processes

Experience training staff on operational and billing workflows

Experience working with tribal health programs, tribal communities, or underserved populations

Understanding of culturally responsive and recovery-oriented care practices

Additional Information American Indian/Alaska Native preference applies

Employment is contingent upon successful completion of a criminal background investigation
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