Behavioral Health Utilization Management Clinical Support Specialist

Cambia•Portland, OR

12d•$26 - $37•Remote

About The Position

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, Cambia's 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. 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 we're 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. We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required. If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected] . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy .

Requirements

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

Nice To Haves

Experience as a Mental Health Technician, Milieu Counselor, or in social work is preferred.
Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Responsibilities

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

Benefits

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.

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