Remote Behavioral Health Utilization Clinician

Cambia Health Solutions; Salem (OR); Remote; USD 43,000 - 70,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

401(k) with company match

Job summary

Cambia Health Solutions in the Pacific Northwest seeks a licensed Behavioral Health Clinician to join our Utilization Management team, focusing on prospective, concurrent, and retrospective reviews to ensure medical necessity and cost-effective outcomes while supporting members’ health journeys.

You will collaborate with physicians, case management, and other departments, maintain documentation, and communicate complex policies clearly.

Qualifications

• Master’s Degree in Behavioral Health Discipline.
• 3 years of utilization management or behavioral health care management experience.
• 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

Behavioral health management

Communication skills

Interdisciplinary collaboration

Office software

Time management

Clinical documentation

Education

Master’s Degree in Behavioral Health

Tools

Microsoft Office

Outlook

Electronic health records

Job description

Cambia Health Solutions in the Pacific Northwest seeks a licensed Behavioral Health Clinician to join our Utilization Management team, focusing on prospective, concurrent, and retrospective reviews to ensure medical necessity and cost-effective outcomes while supporting members’ health journeys.

You will collaborate with physicians, case management, and other departments, maintain documentation, and communicate complex policies clearly.