Behavioral Health Utilization Management Clinical Support Specialist

Behavioral Health Utilization Management Clinical Support Specialist

Work from Home within Oregon Washington Idaho or Utah

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For

Every day Cambias dedicated Clinical Support Specialists are living our mission to make health care easier and make lives better. As a member of the Behavioral Health team our Clinical Support Specialist provides administrative support to the Behavioral Health Utilization Management (UM) team. This includes working with facilities and providers on discharge planning care coordination and communicating determinations. The BH UM Clinical Support Specialist does not make clinical decisions but partners with licensed behavioral health professionals on appropriate actions and responses to support efficient and effective clinical reviews all in service of creating a person-focused health care experience.

Do you have a passion for serving others and learning new things Do you thrive as part of a collaborative caring team Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• 2 years of behavioral health experience or equivalent combination of education and experience to be proficient in all job functions.

• Experience as a Mental Health Technician Milieu Counselor or in social work is preferred.

Skills and Attributes:

• Behavioral health experience in inpatient psychiatric residential treatment partial hospitalization or intensive outpatient settings with demonstrated knowledge of behavioral health terminology DSM-5 diagnostic criteria and coding systems (CPT DX HCPCs)

• Intermediate computer proficiency including Microsoft Office Outlook and Internet search with experience navigating behavioral health care systems EMR documentation billing and claims (significant EMR experience preferred)

• Strong data entry and administrative skills with ability to meet deadlines and achieve operational standards

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

• Strong oral and written communication skills with ability to work effectively both independently and in team environments

• Ability to work in fast-paced environments while maintaining accuracy confidentiality and customer service focus

• Strong organizational skills with ability to prioritize work and manage multiple responsibilities

• Demonstrated ability to mentor co-workers and provide training to new team members

What You Will Do at Cambia:

• Completes non-clinical tasks assigned by BH UM Clinicians related to case completion care coordination and discharge planning including initiating referrals to care management (CM) and single case agreements (SCA) as needed

• Communicates effectively and professionally within and across teams and with providers to prompt concurrent review submissions convey UM determinations cancellations and other necessary communications in compliance with all regulatory and quality requirements

• Facilitates written and verbal notifications to providers to request medical records and additional information ensuring all communications meet regulatory standards and timeliness requirements

• Adheres to all performance criteria including timeliness production and quality standards while performing detailed research and problem-solving using sound decision-making skills to ensure BH UM case accuracy and completeness

• Exhibits excellent time management and organizational skills to ensure all UM activities meet regulatory and quality requirements keeping reference documents policies and procedures readily accessible

• Follows strict guidelines to ensure all work meets corporate standards for accuracy timeliness quality and compliance with federal state BCBSA and accreditation regulations

• Demonstrates and promotes a professional and ethical work environment with all stakeholders while contributing to continuous improvement by identifying opportunities for improvement within systems and workflows and may assist with systems testing if applicable

#LI-Remote

The expected hiring range for a Behavioral Health Utilization Management Clinician is $25.90 - $37.30 an hour depending on skills experience education and training; relevant licensure / certifications; and performance history. The target bonus for this position is 5%. The current full salary range for this role is $24.40 - $42.20 an hour.

About Cambia

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 caring and supportive colleagues are some of the best and brightest in the industry innovating together toward sustainable person-focused health care. Whether were helping members lending a hand to a colleague or volunteering in our communities our compassion empathy and team spirit always shine through.

Why Join the Cambia Team

At Cambia you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match bonus opportunities and more.

In exchange for helping members live healthy lives we offer benefits that empower you to do the same. Just a few highlights include:

• Medical dental and vision coverage for employees and their eligible family members including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.