Remote Behavioral Health Utilization Clinician

Cambia Health Solutions; Provo (UT); Remote; USD 51,000 - 69,000; Full time

Job summary

Cambia Health Solutions in the United States is seeking a Behavioral Health Utilization Management Clinician to perform prospective, concurrent, and retrospective reviews from a remote work setup across Oregon, Washington, Idaho, or Utah. You will apply clinical criteria to determine medical necessity, collaborating with physician advisors to ensure quality and appropriate payments.

The role requires a Master’s degree in Behavioral Health and 3+ years of utilization management plus independent

Qualifications

• Master's degree in Behavioral Health required.
• 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 clinician.
• Proficiency with Microsoft Office, Outlook, and internet search.
• Familiarity with electronic health documentation systems.
• Strong verbal, written, and interpersonal communication with a focus on customer service.
• Ability to interpret and explain complex policies to stakeholders.
• Experience in inpatient hospitals, residential facilities, or partial hospital programs.

Responsibilities

• Perform comprehensive utilization management reviews to ensure medical necessity and policy standards.
• Apply clinical expertise and evidence-based criteria to make determinations, consulting with physician advisors as needed.
• Provide prompt, accurate responses to internal and external inquiries.
• Identify opportunities for quality improvement and participate in related initiatives.
• Maintain meticulous documentation and prioritize assignments to meet performance standards.
• Uphold confidentiality and communicate professionally with members, providers, and regulators.

Skills

Utilization management

BH clinical experience

Advanced BH settings

Industry knowledge

MS Office

EHR familiarity

Communication skills

Policy communication

Education

Master's in Behavioral Health

Job description

Cambia Health Solutions in the United States is seeking a Behavioral Health Utilization Management Clinician to perform prospective, concurrent, and retrospective reviews from a remote work setup across Oregon, Washington, Idaho, or Utah. You will apply clinical criteria to determine medical necessity, collaborating with physician advisors to ensure quality and appropriate payments.

The role requires a Master’s degree in Behavioral Health and 3+ years of utilization management plus independent