Behavioral Health Prior Authorization Specialist

** Please note that you must be licensed in the State of Washington and have 3 years of acute behavioral health experience **  Compact licenses for nurses are not considered

Position Overview: We are seeking a qualified Behavioral Health (BH) professional licensed in the State of Washington to join our team as a Behavioral Health Prior Authorization Specialist. This role is a contract-to-permanent position, fully remote, and open to candidates residing anywhere in the United States, provided they maintain an active Washington State license. The role offers competitive pay at $55.00 per hour and includes medical benefits. Candidates must have the flexibility to work standard business hours, with occasional evening or weekend support as needed.

Key Responsibilities:

• Process prior authorization requests for various levels of care.

• Conduct concurrent review and prior authorizations according to Managed Care Organization policy.

• Assess member services to ensure optimum outcomes, cost-effectiveness, and compliance with state and federal regulations.

• Identify appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.

• Collaborate with interdepartmental teams to enhance continuity of care, including Behavioral Health and Long-Term Care.

• Maintain productivity and quality standards within the department.

• Mentor new team members and actively participate in staff meetings.

• Maintain professional relationships with providers, members, and internal/external customers.

• Refer cases to medical directors as necessary and comply with workplace safety standards.

Knowledge, Skills, and Abilities:

• Demonstrated ability to communicate, problem-solve, and work effectively with individuals at all levels.

• Strong organizational skills and the ability to manage multiple priorities.

• In-depth knowledge of applicable state and federal regulations.

• Familiarity with Interqual and other medical necessity/length of stay guidelines.

• Experience with NCQA standards and utilization management processes.

• Proficiency in Microsoft Office and general computer literacy.

• Excellent verbal and written communication skills.

• Ability to work independently and take initiative to complete tasks.

• Strong understanding of HIPAA compliance and confidentiality requirements.

Required Qualifications:

• Master’s Degree in Social Work, Psychology, or another Behavioral Health field.

• At least 3 years of Behavioral Health hospital acute care or medical experience.

• Active, unrestricted Washington State licensure in one of the following:

  • Licensed Practical Nurse (LPN) or Registered Nurse (RN) with Behavioral Health experience.

  • Licensed Independent Clinical Social Worker (LICSW).

  • Licensed Professional Clinical Counselor (LPCC).

  • Licensed Marriage and Family Therapist (LMFT).

Preferred Qualifications:

• Utilization Management experience.

• Familiarity with managed care practices and policies.

Compensation and Benefits:

• $55.00 per hour.

• Comprehensive medical benefits offered.

Work Environment: This is a fully remote position, requiring a reliable internet connection and a suitable workspace. Candidates must be available to work standard business hours with occasional evening or weekend availability.

If you meet the qualifications and are passionate about delivering high-quality care in a collaborative, remote setting, we encourage you to apply!