Behavioral Health Utilization Management Clinician

Cambia Health Solutions; Salt Lake City (UT); Remote; USD 77,000 - 104,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off (varies by role)

401(k) plan with company match

Parental leave

Wellness programs

Employee Assistance Fund

Job summary

Cambia Health Solutions is seeking a Behavioral Health Utilization Management Clinician to remotely support users in Oregon, Washington, Idaho or Utah. You will perform prospective, concurrent and retrospective reviews to ensure medical necessity and policy alignment, while applying evidence-based criteria and collaborating with physician advisors.

The role emphasizes excellent communication, documentation, and cross‑functional teamwork to ensure patient care transitions and timely issue

Qualifications

• Master’s Degree in Behavioral Health Discipline.
• 3 years of utilization management or behavioral health care management experience.
• Equivalent combination of education and experience.
• 3 years direct Behavioral Health clinical experience as an independently licensed Master's level Behavioral Health Clinician in Psychology, Counselling, Social Work, Marriage or Family Therapy.
• Clinical License must be unrestricted and current in state of residence.
• Must be licensed in WA, OR, ID or UT and willing to be licensed in multiple states.

Responsibilities

• Performs comprehensive utilization management reviews, encompassing prospective, concurrent, and retrospective assessments, to ensure adherence to medical necessity and policy standards.
• Applies clinical expertise and evidence-based criteria to make informed determinations, consulting with physician advisors as necessary to ensure accuracy.
• Fosters collaboration with interdisciplinary teams, case management, and other departments to facilitate seamless transitions of care and resolve issues in a timely and effective manner.
• Serves as a trusted resource, providing prompt and accurate responses to internal and external inquiries, ensuring exceptional customer service.
• Identifies opportunities for improvement and actively participates in quality improvement initiatives to drive excellence.
• Maintains meticulous and consistent documentation, prioritizing assignments to meet performance standards and corporate objectives.
• Upholds the confidentiality of sensitive information and communicates professionally with members, providers, and regulatory organizations, ensuring data protection and integrity.

Skills

Utilization management

Clinical expertise

Customer service

Interdisciplinary collaboration

Documentation

Education

Master’s degree in Behavioral Health

Tools

Microsoft Office

Outlook

EHR systems

Job description

Behavioral Health Utilization Management Clinician Work from home within Oregon, Washington, Idaho or Utah Preference will be given to current employees and candidates who reside in Idaho and Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia’s dedicated team of Clinicians are living our mission to make health care easier and lives better. As a member of the Behavioral Health team, our Clinicians provide utilization management (such as prospective concurrent and retrospective review) to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes and appropriate payment for services – all in service of making our members’ health journeys easier.

Qualifications:

• Master’s Degree in Behavioral Health Discipline
• 3 years of utilization management or behavioral health care management experience
• Equivalent combination of education and experience
• 3 years direct Behavioral Health clinical experience as an independently licensed Master's level Behavioral Health Clinician in one of the areas of Psychology, Counselling, Social Work, Marriage or Family Therapy
• Clinical License must be unrestricted and current in state of residence.
• Must be licensed in WA, OR, ID or UT and willing to be licensed in multiple states.

Skills and Attributes:

• Proficiency in advanced behavioral healthcare settings, including inpatient hospitals, residential facilities, and partial hospital programs
• Staying abreast of the latest developments in the health insurance industry, including trends, technological advancements, and contractual agreements
• Proficient in general computer skills, including Microsoft Office, Outlook, and internet search capabilities
• Familiarity with electronic healthcare documentation systems and their applications
• Possessing exceptional verbal, written, and interpersonal communication skills, with a strong focus on customer service and support
• Ability to accurately interpret and effectively communicate complex policies and procedures to various stakeholders
• Demonstrating strong organizational and time management skills, with the capacity to manage workload independently and prioritize tasks efficiently
• Possessing critical thinking skills, with the ability to make informed decisions within the scope of individual role and responsibility

What You Will Do at Cambia:

• Performs comprehensive utilization management reviews, encompassing prospective, concurrent, and retrospective assessments, to ensure adherence to medical necessity and policy standards.
• Applies clinical expertise and evidence-based criteria to make informed determinations, consulting with physician advisors as necessary to ensure accuracy.
• Fosters collaboration with interdisciplinary teams, case management, and other departments to facilitate seamless transitions of care and resolve issues in a timely and effective manner.
• Serves as a trusted resource, providing prompt and accurate responses to internal and external inquiries, ensuring exceptional customer service.
• Identifies opportunities for improvement and actively participates in quality improvement initiatives to drive excellence.
• Maintains meticulous and consistent documentation, prioritizing assignments to meet performance standards and corporate objectives.
• Upholds the confidentiality of sensitive information and communicates professionally with members, providers, and regulatory organizations, ensuring data protection and integrity.

#LI-Remote Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history. Oregon, Washington, Utah, and Idaho: The expected hiring range is $36.80 – $49.80 an hour, the full salary range is $34.20 – $55.70 an hour and the bonus target is 8%. North Dakota: The expected hiring range is $35.21 - $47.63 an hour and the full salary range is $31.86 - $50.98 an hour.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we’re helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team? At Cambia, you can: Work alongside diverse teams building cutting‑edge solutions to transform health care. Earn a competitive salary and enjoy generous benefits while doing work that changes lives. Grow your career with a company committed to helping you succeed. Give back to your community by participating in Cambia-supported outreach programs. Connect with colleagues who share similar interests and backgrounds through our employee resource groups. We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more. In exchange for helping members live healthy lives, we offer benefits that empower you to do the same.

Just a few highlights include:

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company‑paid holidays.
• Market‑leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award‑winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.
• Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb. As part of our security requirements, new hires will need access to a personal mobile device to set up Multi‑Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.

We are an Equal Opportunity employer dedicated to a drug and tobacco‑free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required. If you need accommodation for any part of the application process because of a medical condition or disability, please email [e-mail]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

Cambia Health Solutions is a family of companies headquartered in Portland, Oregon, working to make healthcare simpler, more affordable and more person‑focused. Through our regional health insurance plans, innovative technologies and strategic investments, we are delivering consumer‑centric solutions that:

• Help people achieve better health and well-being
• Make healthcare more available, affordable, and personalized
• Are easily understood by everyone

We put people at the heart of everything we do. Our company reaches more than 70 million Americans nationwide, including more than 6 million people enrolled in our regional health plans. Cambia blends data science with a compassionate human perspective to anticipate people’s needs, and empower them to make smarter health care choices.

Interested in driving accessibility, affordability and quality health care for real people? join the Twitter conversation @Cambia. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.