Behavioral Health Utilization Management Clinician ABA

Cambia Health Solutions • Medford, OR

95d • $42 - $44

About The Position

Cambia’s dedicated team of Clinicians are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Behavioral Health Clinician provides utilization management (such as prospective concurrent and retrospective review) to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes and appropriate payment for services – all in service of making our members’ health journeys easier. Are you someone who has a passion for healthcare? Are you a Clinician who is ready to take your career to the next level and make a real difference in the lives of our members? Then this role may be the perfect fit.

Requirements

• Bachelor’s degree in a related field.
• 3 years direct behavioral Health clinical experience as an independently licensed BCBA (Board Certified Behavioral Analyst).
• Clinical License must be unrestricted and current in state of residence.
• Must have licensure or certification in a state or territory of the United States in a health or human services discipline that allows the professional to conduct an assessment independently.
• Independent licensed Master's level Behavioral Health Clinician preferred in the areas of Psychology, Counselling, Social Work, or Marriage and Family Therapy (LICSW, LCSW, LMHC, LPC and LMFT).

Nice To Haves

• Knowledge of health insurance industry trends, technology and contractual arrangements.
• General computer skills (including use of Microsoft Office, Outlook, internet search).
• Familiarity with health care documentation systems.
• Strong verbal, written and interpersonal communication and customer service skills.
• Ability to interpret policies and procedures and communicate complex topics effectively.
• Strong organizational and time management skills with the ability to manage workload independently.
• Ability to think critically and make decisions within individual role and responsibility.

Responsibilities

• Conducts utilization management reviews (prospective, concurrent, and retrospective) to ensure medical necessity and compliance with policy and standards of care.
• Applies clinical expertise and evidence-based criteria to make determinations and consults with physician advisors as needed.
• Collaborates with interdisciplinary teams, case management, and other departments to facilitate transitions of care and resolve issues.
• Serves as a resource to internal and external customers, providing accurate and timely responses to inquiries.
• Identifies opportunities for improvement and participates in quality improvement efforts.
• Maintains accurate and consistent documentation and prioritizes assignments to meet performance standards and corporate goals.
• Protects confidentiality of sensitive documents and issues while communicating professionally with members, providers, and regulatory organizations.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees