Remote Behavioral Health UM Clinician

Cambia Health; Medford (OR); Remote; USD 48,000 - 79,000; Full time

Job summary

Cambia Health is seeking a Behavioral Health Utilization Management Clinician to perform prospective, concurrent, and retrospective reviews ensuring medical necessity and policy alignment, while supporting member care. The role collaborates with multidisciplinary teams to improve outcomes and cost efficiency.

A Master’s in Behavioral Health and 3 years of UM experience are required, with multi-state licensure supported.

Qualifications

• Master’s degree in Behavioral Health required.
• 3 years in utilization management or behavioral health care management.
• Unrestricted clinical license in state of residence.
• Licensed in WA, OR, ID or UT with willingness to license in multiple states.
• Strong communication and organizational skills.
• Proficient with MS Office and internet research.

Responsibilities

• Perform prospective, concurrent and retrospective utilization reviews.
• Apply clinical criteria and consult physician advisors when needed.
• Collaborate with case management and other departments for transitions of care.
• Provide prompt, accurate responses to inquiries and maintain documentation.
• Identify opportunities for improvement and participate in quality initiatives.
• Maintain confidentiality and professional communication with stakeholders.

Skills

Licensing in WA/OR/ID/UT (unrestricted

Communication & customer service

Time management

Interdisciplinary collaboration

Policy interpretation

Education

Master's Degree in Behavioral Health Discipline

Tools

EHR systems

Job description

Cambia Health is seeking a Behavioral Health Utilization Management Clinician to perform prospective, concurrent, and retrospective reviews ensuring medical necessity and policy alignment, while supporting member care. The role collaborates with multidisciplinary teams to improve outcomes and cost efficiency.

A Master’s in Behavioral Health and 3 years of UM experience are required, with multi-state licensure supported.