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