Remote Behavioral Health Utilization Clinician

Cambia Health Solutions; Idaho; Remote; USD 73,000 - 118,000; Full time

Benefits offered by this job

Medical, Dental and Vision coverage

Paid time off

401(k) with company match

Parental leave

Wellness programs

Job summary

Cambia Health Solutions is hiring a licensed Behavioral Health Clinician to perform utilization management reviews and ensure medical necessity adherence. You will collaborate with physician advisors and multidisciplinary teams to optimize care transitions and outcomes.

The role emphasizes strong communication, clinical judgment, and adherence to policy, with remote work options and a flexible structure to support patient-focused care.

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, Counseling, 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, 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.

Skills

Utilization management

Communication skills

Interdisciplinary collaboration

Education

Master’s Degree in Behavioral Health

Tools

Microsoft Office

Outlook

EHR systems

Job description

Cambia Health Solutions is hiring a licensed Behavioral Health Clinician to perform utilization management reviews and ensure medical necessity adherence. You will collaborate with physician advisors and multidisciplinary teams to optimize care transitions and outcomes.

The role emphasizes strong communication, clinical judgment, and adherence to policy, with remote work options and a flexible structure to support patient-focused care.