Remote Behavioral Health Utilization Clinician

NurseRemotely; United States; Remote; USD 105,447,000 - 142,697,000; Full time

Job summary

Cambia Health Solutions is seeking a Behavioral Health Utilization Management Clinician to work from home within Oregon, Washington, Idaho or Utah. The role focuses on applying utilization management to ensure medical necessity and cost-effective outcomes while supporting members through their health journeys.

You will review cases, collaborate with physicians and other teams, maintain clear documentation, and uphold confidentiality.

Qualifications

• Master’s degree in Behavioral Health.
• 3 years in utilization management or behavioral health care management.
• Equivalent combination of education and experience.
• 3 years direct Behavioral Health clinical experience as an independently licensed Master’s level clinician in psychology, counselling, social work, marriage or family therapy.
• Clinical license must be unrestricted and current; eligible in WA, OR, ID or UT and willing to be licensed in multiple states.

Responsibilities

• Performs comprehensive utilization management reviews (prospective, concurrent, retrospective).
• Applies clinical criteria and consults with physician advisors for accuracy.
• Collaborates with interdisciplinary teams to facilitate transitions of care.
• Responds to inquiries with prompt, accurate, customer-focused service.
• Identifies opportunities for quality improvement and participates in initiatives.
• Maintains meticulous documentation to meet performance standards.
• Upholds confidentiality and communicates professionally with stakeholders.

Skills

Utilization management

Behavioral health

Clinical licensing

Interstate licensure

Communication skills

Education

Master's degree in Behavioral Health

Tools

Microsoft Office

Outlook

Electronic health records

Job description

Cambia Health Solutions is seeking a Behavioral Health Utilization Management Clinician to work from home within Oregon, Washington, Idaho or Utah. The role focuses on applying utilization management to ensure medical necessity and cost-effective outcomes while supporting members through their health journeys.

You will review cases, collaborate with physicians and other teams, maintain clear documentation, and uphold confidentiality.