Behavioral Health Utilization Management Clinician

Cambia Health Solutions; Spokane (WA); Remote; USD 66,000 - 107,000; Full time

Benefits offered by this job

Medical, dental & vision coverage

401(k) with company match

Paid time off and holidays

Parental leave up to 12 weeks

Wellness programs

Job summary

Cambia Health Solutions is hiring a licensed Behavioral Health Clinician to join the Utilization Management team. This role focuses on prospective, concurrent, and retrospective reviews to ensure medical necessity and efficient care.

The candidate will apply evidence-based criteria, collaborate with physician advisors, and work with interdisciplinary teams to optimize transitions of care while maintaining strong documentation and customer service.

Qualifications

• Master’s degree in Behavioral Health and an unrestricted clinical license in WA, OR, ID or UT.
• Minimum 3 years of utilization management or behavioral health care management experience.
• Licensed Behavioral Health Clinician with independence in at least one area.

Responsibilities

• Perform comprehensive utilization management reviews (prospective, concurrent, retrospective) to ensure medical necessity and policy adherence.
• Apply clinical expertise and evidence-based criteria, consulting physician advisors as needed.
• Collaborate with interdisciplinary teams to facilitate transitions of care and resolve issues quickly.
• Provide prompt, accurate responses to inquiries, ensuring strong customer service.
• Identify opportunities for quality improvement and participate in related initiatives.
• Maintain meticulous documentation to meet performance standards.
• Uphold confidentiality and communicate professionally with members, providers, and regulators.

Skills

Behavioral healthcare

Health insurance trends

MS Office

EHR systems

Communication skills

Policy interpretation

Time management

Critical thinking

Education

Master’s Degree in Behavioral Health Discipline

Tools

Microsoft Office

EHR systems

Job description

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.

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.

Are you a licensed Clinician with a passion for Utilization Management wanting to make a career change? Are you wanting to make positive change in people's lives and healthcare? Then this role may be the perfect fit.

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.

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.

National pay structure — applies to the Boise, Portland, Salem, Seattle/Renton/Tacoma, Burlington, Vancouver, and Salt Lake City metro areas. The full salary range is $35.00 - $57.00 and the bonus target is 8%. The expected salary range is $37.20 - $50.40.

Regional pay structure — applies to North Dakota and to Idaho, Oregon, Washington, and Utah locations outside the metro areas listed above. The full salary range is $31.50 - $51.30 and the bonus target is 8%. The expected salary range is $33.50 - $45.30.

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.

Benefits

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].