Care Management Behavioral Health Specialist

🔥 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

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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

• Provide clinical care management, including case management, disease management, and/or care coordination • Oversee a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate member care • Collect in-depth information about member situations and functioning to identify needs • Develop objectives, goals, and actions to address member needs • Execute case management activities and organize, secure, integrate, and modify resources • Gather information to determine plan effectiveness and measure outcomes • Apply clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and standards of care • Use evidence-based criteria incorporating current and validated clinical research • Practice within scope of license and consult physician advisors for clinically appropriate determinations • Serve as a resource to internal and external customers • Collaborate with departments to resolve claims, quality-of-care, member, or provider issues • Respond professionally to members, providers, and regulatory organizations while protecting confidentiality • Identify problems or needed changes and recommend resolutions • Participate in quality improvement efforts • Provide consistent, accurate documentation • Plan, organize, and prioritize assignments to meet performance standards, corporate goals, and timelines

🎯 Requirements

• Associate or Bachelor’s Degree in Nursing, Behavioral Health, or related field • 3 years of case management, utilization management, disease management, or behavioral health case management experience, or equivalent combination of education and experience • Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows independent assessment within the scope of practice • At least 3 years (or full-time equivalent) of direct clinical care • Knowledge of health insurance industry trends, technology, and contractual arrangements • General computer skills, including Microsoft Office, Outlook, and internet search • Familiarity with health care documentation systems • Ability to interpret policies and procedures • Experience with AI tools and technologies highly desired • Strong oral, written, interpersonal communication, and customer service skills • Ability to communicate complex topics effectively • Strong organization and time management skills; ability to manage workload independently • Ability to think critically and make decisions within individual role and responsibility • Personal mobile device required for MFA • Wired internet connection required; not satellite or cellular; minimum 5Mb upload and 10Mb download • Background check required

🏖️ Benefits

• Competitive base pay • Market-leading 401(k) with a significant company match • Bonus opportunities; 10% bonus target • 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 varying by role and tenure • 10 company-paid holidays • Market-leading retirement plan with company match and potential discretionary contribution based on company performance; 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 requirement support for remote work • Employee resource groups • Cambia-supported community outreach programs