Remote Behavioral Health Utilization Clinician (WA/OR/ID/UT)

Cambia Health; Bellevue (WA); Remote; USD 48,000 - 79,000; Full time

Job summary

Cambia Health is seeking a Behavioral Health Utilization Management Clinician. This role supports prospective, concurrent and retrospective reviews to assess medical necessity and policy alignment, applying evidence-based criteria and coordinating with physicians to ensure optimal patient outcomes.

Candidates should have a Master's in Behavioral Health and an unrestricted license in WA/OR/ID or UT, with multi-state licensure preferred.

Qualifications

• Master's degree in a behavioral health discipline and active licensure in WA/OR/ID/UT.
• Minimum 3 years in utilization management or behavioral health care management.
• Independent licensed clinician with 3 years in psychology, counseling, social work, or therapy.
• Unrestricted and current clinical license in residence state; multi-state licensing preferred.
• Strong familiarity with health insurance concepts and policy interpretation.

Responsibilities

• Perform comprehensive utilization management reviews (prospective, concurrent and retrospective).
• Apply clinical criteria and consult physician advisors for accuracy.
• Collaborate with interdisciplinary teams to ensure appropriate transitions of care.
• Provide prompt, accurate responses to inquiries with strong customer service.
• Identify improvement opportunities and participate in quality initiatives.
• Maintain meticulous documentation and meet performance goals.
• Protect confidentiality and communicate professionally with members, providers and regulators.

Skills

Behavioral health expertise

Communication skills

Customer service

Time management

Education

Master's Degree in Behavioral Health Discipline

3 years utilization management or behavioral health care management experience

3 years direct Behavioral Health clinical experience as an independently licensed Master's level Clinician

Clinical License unrestricted and current in state of residence

Licensed in WA, OR, ID or UT

Job description

Cambia Health is seeking a Behavioral Health Utilization Management Clinician. This role supports prospective, concurrent and retrospective reviews to assess medical necessity and policy alignment, applying evidence-based criteria and coordinating with physicians to ensure optimal patient outcomes.

Candidates should have a Master's in Behavioral Health and an unrestricted license in WA/OR/ID or UT, with multi-state licensure preferred.