Medical Policy Clinician

Cambia Health Solutions, Inc.; Utah; Remote; USD 51,000 - 69,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Annual health savings account (HSA)

Paid time off + 10 company holidays

401(k) retirement plan with company 
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Up to 12 weeks parental leave

Job summary

Cambia Health Solutions, Inc. is seeking a Behavioral Health Utilization Management Clinician to work from home within Oregon, Washington, Idaho or Utah.

You’ll perform prospective, concurrent and retrospective reviews to support medically necessary care while promoting cost-effective outcomes. The role requires a licensed clinician with a master’s in behavioral health and experience in utilization management, using Microsoft Office tools and electronic health records.

Qualifications

• Master’s Degree in Behavioral Health Discipline is required.
• Licensed Clinician status is expected.
• Proficiency in Microsoft Office, Outlook and internet search.

Responsibilities

• Perform comprehensive utilization management reviews (prospective, concurrent, retrospective).
• Apply clinical expertise and evidence-based criteria for determinations with physician consults as needed.
• Respond to internal/external inquiries promptly with accurate information.
• Identify opportunities for quality improvement and participate in initiatives.
• Maintain meticulous documentation to meet performance standards and privacy obligations.

Skills

Verbal communication

Written communication

Interpersonal skills

Customer service

Policy interpretation

Education

Master’s Degree in Behavioral Health

Licensed Behavioral Health Clinician

Tools

Microsoft Office

Outlook

Electronic health record systems

Job description

Behavioral Health Utilization Management Clinician (Work from home within Oregon, Washington, Idaho or Utah)

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?

• Master’s Degree in Behavioral Health Discipline
• 3 years of utilization management or behavioral health care management 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
• 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

• 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.
• 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

The expected hiring range depends on skills, experience, education, and training; 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%.

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.

Work alongside diverse teams building cutting-edge solutions to transform health care.

Grow your career with a company committed to helping you succeed.

Give back to your community by participating in Cambia-supported outreach programs.

Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

• 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).

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.

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.

If you need accommodation for any part of the application process because of a medical condition or disability, please email about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.