Behavioral Health Utilization Management Clinician

Behavioral Health Utilization Management Clinician at Cambia Health Solutions

Work from home within Oregon, Washington, Idaho or Utah.

As a member of the Behavioral Health team, Clinicians provide utilization management (such as prospective, concurrent and retrospective review) to meet member healthcare needs and promote quality and cost-effective outcomes, ensuring appropriate payment for services.

• Performs comprehensive utilization management reviews (prospective, concurrent and retrospective) to ensure medical necessity and policy standards.
• Applies clinical expertise and evidence-based criteria to make determinations, consulting with physician advisors as needed.
• Collaborates with interdisciplinary teams, case management, and other departments to facilitate transitions of care and resolve issues promptly.
• Responds to internal and external inquiries with accurate information and strong customer service.
• Identifies opportunities for improvement and participates in quality improvement initiatives.
• Maintains meticulous documentation and prioritizes assignments to meet performance standards and corporate objectives.
• Upholds confidentiality and communicates professionally with members, providers, and regulatory organizations.

• 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 of direct behavioral health clinical experience as an independently licensed Master’s level clinician in psychology, counseling, social work, marriage or family therapy
• Clinical license must be unrestricted and current in state of residence; licensed in WA, OR,  UT and willing to be licensed in multiple states

• Experience in advanced behavioral healthcare settings (inpatient, residential, partial hospital programs)
• Knowledge of health insurance industry trends, technology, and contractual agreements
• Proficient in Microsoft Office, Outlook, and internet search
• Familiarity with electronic healthcare documentation systems
• Strong verbal, written, and interpersonal communication with a customer service focus
• Ability to interpret and communicate complex policies to various stakeholders
• Strong organizational and time management skills with ability to work independently
• Critical thinking and decision-making within scope of role

• Perform comprehensive utilization management reviews to ensure medical necessity and policy adherence.
• Apply clinical expertise and criteria to determine outcomes, consulting with physician advisors as needed.
• Collaborate with interdisciplinary teams to facilitate smooth transitions of care and address issues promptly.
• Provide prompt, accurate responses to inquiries and maintain high-quality customer service.
• Identify opportunities for improvement and participate in quality initiatives.
• Maintain clear, consistent documentation and manage workload to meet performance goals.
• Protect confidentiality and communicate professionally with members, providers, and regulatory entities.

The expected hiring range for a Behavioral Health Utilization Management Clinician is $42.00 - $44.00 per hour, depending on skills, experience, education, licensure/certifications, and performance history. Bonus target: 10%. The full salary range for this role is $33.80 - $55.00 per hour.

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our colleagues are committed to sustainable, person-focused health care and community involvement.

• Work with diverse teams building solutions to transform health care
• Earn a competitive salary and robust benefits
• Grow your career with a company committed to your success
• Participate in Cambia-supported outreach programs
• Engage with employee resource groups

Our compensation package includes competitive base pay, a market-leading 401(k) with generous company match, bonus opportunities, and more.

• Medical, dental and vision coverage for employees and eligible family members, including mental health benefits
• Annual employer contribution to a health savings account
• Generous paid time off and 10 company-paid holidays
• Retirement plan with company match and possible discretionary contributions
• Up to 12 weeks of paid parental leave (eligibility requires 12 months of service)
• Wellness programs, Employee Assistance Fund, and other benefits

We offer work-from-home options for many roles with requirements for a wired internet connection (no satellite or cellular) and minimum speeds: upload 5 Mb, download 10 Mb.

We are an Equal Opportunity employer in a drug- and tobacco-free workplace. Background check required. If you need accommodation during the application process due to a medical condition or disability, please email C Details about our data practices are in our Privacy Policy.