Remote Behavioral Health Utilization Clinician

Cambia Health; Spokane (WA); Remote; USD 51,000 - 69,000; Full time

Benefits offered by this job

Work from home options

Health benefits

401(k) retirement plan

Paid time off

Job summary

Cambia Health is seeking a Behavioral Health Utilization Management Clinician. The role involves conducting prospective, concurrent, and retrospective reviews to ensure medical necessity and policy adherence, with collaboration across care teams.

Licensed clinicians will apply evidence-based criteria, support access to appropriate services, and help improve care transitions while maintaining robust documentation and confidentiality in a flexible, remote-capable environment.

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 clinician
• 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.
• Applies clinical expertise and evidence-based criteria to make informed 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

Advanced behavioral health knowledge

Licensure & compliance

Interpersonal communication

Organization & time management

Decision making

Education

Master's Degree in Behavioral Health Discipline

Tools

Microsoft Office

Outlook

EHR systems

Job description

Cambia Health is seeking a Behavioral Health Utilization Management Clinician. The role involves conducting prospective, concurrent, and retrospective reviews to ensure medical necessity and policy adherence, with collaboration across care teams.

Licensed clinicians will apply evidence-based criteria, support access to appropriate services, and help improve care transitions while maintaining robust documentation and confidentiality in a flexible, remote-capable environment.