Remote Behavioral Health Utilization Clinician

Cambia Health; Boise (ID); Remote; USD 48,000 - 79,000; Full time

Job summary

Cambia Health is seeking a Behavioral Health Utilization Management Clinician to support remote work within OR, WA, ID or UT. You will conduct prospective, concurrent and retrospective reviews to ensure medical necessity and alignment with policy, collaborating with physician advisors as needed.

The role requires a licensed behavioral health clinician with 3+ years of utilization management experience, strong communication and organizational skills, and ability to work across departments to

Qualifications

• Master's degree in behavioral health discipline is required.
• Minimum 3 years of utilization management or behavioral health care management experience.
• Licensed independent Master's level clinician in psychology, counseling, social work, marriage or family therapy.
• License must be unrestricted and current in state of residence; multi-state licensing preferred.

Responsibilities

• Perform comprehensive utilization management reviews (prospective, concurrent, retrospective).
• Apply clinical criteria and consult physician advisors to determine medical necessity.
• Collaborate with interdisciplinary teams to facilitate transitions of care.
• Provide prompt, accurate responses to inquiries and ensure customer service.
• Identify process improvements and participate in quality initiatives.
• Maintain meticulous documentation and manage workload to meet performance goals.
• Protect confidentiality and communicate professionally with members, providers and regulators.

Skills

Utilization management

Interdisciplinary collaboration

Microsoft Office

EHR systems

Communication skills

Time management

Critical thinking

Policy interpretation

Education

Master's Degree in Behavioral Health Discipline

Unrestricted clinical license in state of residence

Job description

Cambia Health is seeking a Behavioral Health Utilization Management Clinician to support remote work within OR, WA, ID or UT. You will conduct prospective, concurrent and retrospective reviews to ensure medical necessity and alignment with policy, collaborating with physician advisors as needed.

The role requires a licensed behavioral health clinician with 3+ years of utilization management experience, strong communication and organizational skills, and ability to work across departments to