Remote Behavioral Health Utilization Clinician

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

Benefits offered by this job

Medical, dental and vision coverage

Health savings account contributions

Paid time off and holidays

Competitive retirement plan with 401(k

Parental leave

Job summary

Cambia Health is seeking a Behavioral Health Utilization Management Clinician to support members remotely across OR, WA, ID, and UT. The role focuses on prospective, concurrent, and retrospective reviews to ensure medical necessity and cost-effective care.

The ideal candidate has a Master’s in Behavioral Health, at least 3 years in utilization management and clinical licensure in WA/OR/ID/UT. The position emphasizes collaboration, data integrity, and professional communication with providers and

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, 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 experience

Behavioral health clinical experience

Licensed clinician

Multi-state licensure

Education

Master's degree in Behavioral Health

Job description

Cambia Health is seeking a Behavioral Health Utilization Management Clinician to support members remotely across OR, WA, ID, and UT. The role focuses on prospective, concurrent, and retrospective reviews to ensure medical necessity and cost-effective care.

The ideal candidate has a Master’s in Behavioral Health, at least 3 years in utilization management and clinical licensure in WA/OR/ID/UT. The position emphasizes collaboration, data integrity, and professional communication with providers and