Kaiser Utilization Review Liaison at Benchmark Young Adult School PMB K-286 – Montclair, California

Position Details

Department: Clinical Operations / Partnerships

Reports To: Regional Executive Director

FLSA Status: Exempt

Employment Type: Full-Time

The Kaiser Utilization Review Liaison serves as the primary point of contact between Benchmark Transitions and Kaiser Permanente, facilitating communication, coordinating care authorization, and supporting ongoing utilization review activities across residential and outpatient levels of care. This role requires a strong understanding of Kaiser Permanente's systems, processes, and expectations, combined with clinical knowledge of behavioral health and substance use disorder treatment.

Utilization Review & Authorization

• Conduct and coordinate concurrent utilization review for Kaiser Permanente members across all applicable levels of care.
• Initiate and manage prior authorization requests, continued stay reviews, and discharge planning communications with Kaiser.
• Ensure timely submission of clinical documentation to support medical necessity determinations.
• Track and monitor authorization status for all Kaiser-referred clients and proactively address any denials or gaps.
• Collaborate with clinical staff to gather and present relevant clinical information supporting continued stay or level-of-care transitions.

• Serve as the primary liaison between Benchmark Transitions and Kaiser Permanente case managers, clinical reviewers, and referral coordinators.
• Maintain up-to-date knowledge of Kaiser Permanente's behavioral health protocols, care pathways, and documentation requirements.
• Participate in joint operating committee meetings, case consultations, and any partnership calls with Kaiser representatives.
• Support the intake and admissions process for Kaiser-referred clients, ensuring smooth transitions into care.
• Identify and communicate trends in Kaiser referral patterns, authorization outcomes, and clinical feedback to leadership.

• Maintain accurate and complete records of all utilization review activities, authorization approvals, and denial management in accordance with regulatory and payer requirements.
• Ensure clinical documentation in the electronic health record (EHR) aligns with Kaiser Permanente's standards and supports medical necessity.
• Support compliance with state and federal requirements related to utilization management and managed care.
• Prepare and submit appeals for denied authorizations in a timely and thorough manner.

• Partner with clinical, case management, and admissions teams to align treatment planning with Kaiser authorization requirements.
• Participate in multidisciplinary treatment team meetings as needed.
• Communicate authorization updates and payer expectations to program staff in a clear and timely manner.
• Support discharge planning processes to facilitate appropriate step-down care and continued coordination with Kaiser.

One of the following is required:

• Master’s degree in Social Work, Counseling, Psychology, or a related behavioral health field
• Certified Alcohol and Drug Counselor (CADC) or equivalent certification
• Licensed Vocational Nurse (LVN) or Registered Nurse (RN)
• Or equivalent combination of clinical education and relevant credentialing in behavioral health

• Minimum 2 years of experience in utilization review, case management, or managed care within a behavioral health or substance use disorder treatment setting.
• Direct experience working with Kaiser Permanente as a payer, including familiarity with Kaiser’s authorization systems, clinical review standards, and escalation processes — required.
• Demonstrated knowledge of medical necessity criteria (e.g., ASAM, MCG/InterQual) as applied to behavioral health levels of care.
• Experience with residential, PHP, IOP, and outpatient behavioral health programs preferred.
• Proficiency with electronic health record systems; experience with Kipu a plus.

• Strong written and verbal communication skills with the ability to present clinical information clearly and persuasively.
• Highly organized with the ability to manage multiple concurrent authorizations and deadlines.
• Collaborative team player with the ability to work across clinical, operational, and administrative functions.
• Knowledge of California managed care regulations and behavioral health parity laws.
• Ability to work independently and exercise sound clinical and professional judgment.

PHYSICAL REQUIREMENTS

This position may require prolonged periods of sitting and working at a computer. Occasional travel to program sites may be required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role. Benchmark Transitions by Emend Healthcare is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.