Remote Behavioral Health Utilization Management Clinician

Cambia Health Solutions; Spokane (WA); Remote; USD 66,000 - 107,000; Full time

Benefits offered by this job

Medical, dental & vision coverage

401(k) with company match

Paid time off and holidays

Parental leave up to 12 weeks

Wellness programs

Job summary

Cambia Health Solutions is hiring a licensed Behavioral Health Clinician to join the Utilization Management team. This role focuses on prospective, concurrent, and retrospective reviews to ensure medical necessity and efficient care.

The candidate will apply evidence-based criteria, collaborate with physician advisors, and work with interdisciplinary teams to optimize transitions of care while maintaining strong documentation and customer service.

Qualifications

• Master’s degree in Behavioral Health and an unrestricted clinical license in WA, OR, ID or UT.
• Minimum 3 years of utilization management or behavioral health care management experience.
• Licensed Behavioral Health Clinician with independence in at least one area.

Responsibilities

• Perform comprehensive utilization management reviews (prospective, concurrent, retrospective) to ensure medical necessity and policy adherence.
• Apply clinical expertise and evidence-based criteria, consulting physician advisors as needed.
• Collaborate with interdisciplinary teams to facilitate transitions of care and resolve issues quickly.
• Provide prompt, accurate responses to inquiries, ensuring strong customer service.
• Identify opportunities for quality improvement and participate in related initiatives.
• Maintain meticulous documentation to meet performance standards.
• Uphold confidentiality and communicate professionally with members, providers, and regulators.

Skills

Behavioral healthcare

Health insurance trends

MS Office

EHR systems

Communication skills

Policy interpretation

Time management

Critical thinking

Education

Master’s Degree in Behavioral Health Discipline

Tools

Microsoft Office

EHR systems

Job description

Cambia Health Solutions is hiring a licensed Behavioral Health Clinician to join the Utilization Management team. This role focuses on prospective, concurrent, and retrospective reviews to ensure medical necessity and efficient care.

The candidate will apply evidence-based criteria, collaborate with physician advisors, and work with interdisciplinary teams to optimize transitions of care while maintaining strong documentation and customer service.