Behavioral Health Utilization Management Clinician

🔥 0 minutes ago

🥔 Idaho, Oregon, +2 more states – Remote

🥔 Idaho – Remote 🌲 Oregon – Remote ⛷️ Utah – Remote ☕ Washington – Remote

💵 $34 - $55 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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Cambia Health Solutions

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

Cambia Health Solutions is a nonprofit, mission-driven healthcare company based in Portland, Oregon, that operates consumer-focused health care and health insurance businesses and invests in health innovation. It serves as the parent organization for the Regence family of health plans and runs initiatives and subsidiaries focused on improving care delivery, providing insurance products, and developing digital health tools and services.

📋 Description

• Perform comprehensive prospective, concurrent, and retrospective utilization management reviews • Ensure adherence to medical necessity and policy standards • Apply clinical expertise and evidence-based criteria to make determinations • Consult physician advisors as necessary • Collaborate with interdisciplinary teams, case management, and other departments to facilitate transitions of care and resolve issues • Respond promptly and accurately to internal and external inquiries • Provide exceptional customer service • Identify improvement opportunities and participate in quality improvement initiatives • Maintain accurate and consistent documentation • Prioritize assignments to meet performance standards and corporate objectives • Protect confidential information • Communicate professionally with members, providers, and regulatory organizations

🎯 Requirements

• 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 Behavioral Health Clinician • Experience in Psychology, Counselling, Social Work, Marriage or Family Therapy • Unrestricted and current clinical license in state of residence • Must be licensed in WA, OR, ID or UT and willing to be licensed in multiple states • Proficiency in advanced behavioral healthcare settings, including inpatient hospitals, residential facilities, and partial hospital programs • Knowledge of health insurance industry developments, trends, technological advancements, and contractual agreements • Proficiency in Microsoft Office, Outlook, and internet search capabilities • Familiarity with electronic healthcare documentation systems • Strong verbal, written, and interpersonal communication skills • Ability to interpret and communicate complex policies and procedures • Strong organizational and time management skills • Critical thinking and informed decision-making skills • Background check required • Access to a personal mobile device for Multi-Factor Authentication • Wired internet connection with minimum 5Mb upload and 10 Mb download speeds; satellite or cellular internet is not accepted

🏖️ Benefits

• Competitive salary • Generous benefits • 401(k) with a significant company match • Bonus opportunities • 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 • 10 company-paid holidays • Retirement plan with company match and potential discretionary contribution based on company performance, with no vesting period • Up to 12 weeks of paid parental time off after 12 months of continuous service • Award-winning wellness programs that reward participation • Employee Assistance Fund • Commute and parking benefits • Work-from-home options • Wired internet connection requirement for work-from-home employees • Employee resource groups • Community outreach programs • Personal mobile device support for Multi-Factor Authentication