Remote Behavioral Health Utilization Clinician

Cambia Health; Coeur d'Alene (ID); Remote; USD 48,000 - 79,000; Full time

Benefits offered by this job

Work from home options

Job summary

Cambia Health Solutions is seeking a Behavioral Health Utilization Management Clinician to support care decisions across multiple states. This remote-friendly role emphasizes clinical expertise, regulatory compliance, and collaboration with care teams to ensure medical necessity and cost-effectiveness.

You will review prospective, concurrent, and retrospective cases, apply evidence-based criteria, and communicate findings to providers. Licensure in WA/OR/ID/UT is required or planned.

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 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.

Responsibilities

• Performs comprehensive utilization management reviews: prospective, concurrent, and retrospective.
• Applies clinical expertise and evidence-based criteria to make determinations, consulting with physician advisors as necessary.
• 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.

Skills

Behavioral health utilization

Utilization management

Multi-state licensure

Clinical communication

Inpatient/outpatient knowledge

Education

Master's Degree in Behavioral Health Discipline

Job description

Cambia Health Solutions is seeking a Behavioral Health Utilization Management Clinician to support care decisions across multiple states. This remote-friendly role emphasizes clinical expertise, regulatory compliance, and collaboration with care teams to ensure medical necessity and cost-effectiveness.

You will review prospective, concurrent, and retrospective cases, apply evidence-based criteria, and communicate findings to providers. Licensure in WA/OR/ID/UT is required or planned.