Utilization Management Specialist

Job Location: Jamestown Salish Seasons - Sequim, WA 98382
Salary Range: $31.74 - $41.26 Hourly
Position Type: Full Time

Jamestown S’Klallam Tribe is expanding its healthcare offerings in the form of a brand new, state-of-the-art Evaluation and Treatment (E&T) Center, named Jamestown Salish Seasons, constructed on the Jamestown Healing Campus.

This facility is the first and only Tribally owned and operated E&T in Washington State.

It is classified as a freestanding, 16-bed Residential Treatment Facility (RTF) designed to provide 24/7/365 behavioral health inpatient treatment, including crisis stabilization, diagnosis, medication management, and more.

The Center’s operational focus is on voluntary treatment as opposed to involuntary, ensuring our treatment offerings are designed from the ground up to provide world-class, recovery-oriented care.

We are committed to evidence-based, culturally responsive, and trauma-informed treatment that honors our mission, values, and standards for quality and safety.

This is a full-time position that will work on a schedule of 4 10-hour shifts per week.

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.

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 efficiencies

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,…