Behavioral Health Utilization Management Clinician

Cambia Health Solutions; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

A health solutions company is looking for a Behavioral Health Utilization Management Clinician to work remotely from Oregon, Washington, Idaho, or Utah. The role involves providing utilization management to meet member healthcare needs while ensuring quality outcomes. The ideal candidate will have a master's degree in a behavioral health discipline and a passion for making a positive impact in healthcare.

Qualifications

• Licensed Clinician with a passion for Utilization Management.
• 3 years of utilization management or behavioral health care management experience.
• 3 years direct Behavioral Health clinical experience in psychology, counseling, social work, marriage, or family therapy.

Responsibilities

• Perform comprehensive utilization management reviews.
• Consult with physician advisors to ensure accuracy of determinations.
• Collaborate with interdisciplinary teams to facilitate care transitions.
• Provide prompt and accurate responses to inquiries.
• Participate in quality improvement initiatives.
• Maintain meticulous documentation.

Skills

Proficiency in advanced behavioral healthcare settings

Exceptional verbal and written communication skills

Strong organizational and time management skills

Critical thinking skills

Education

Master’s Degree in Behavioral Health Discipline

Tools

Microsoft Office

Electronic healthcare documentation systems

Job description

Behavioral Health Utilization Management Clinician

Work from home within Oregon, Washington, Idaho or 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 to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes and appropriate payment for services.

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.

What You Bring to Cambia:

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.

Cambia is 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.