Behavioral Health Utilization Management Clinician

Cambia Health Solutions

. Perform comprehensive prospective, concurrent, and retrospective utilization management reviews .

Posted 10/2/2026full-timeRemote • United StatesMid-LevelSenior💰 $34 - $56 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management and Behavioral Health, with a strong focus on clinical decision-making, adherence to medical necessity standards, and effective collaboration with interdisciplinary teams. Proficient in managing complex cases while ensuring compliance with regulatory requirements and delivering exceptional customer service.

Highest-signal resume keywords

Master’s Degree in Behavioral Health Discipline3 Years of Utilization Management ExperienceLicensed Behavioral Health ClinicianProficiency in Microsoft OfficeStrong Verbal and Written Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ManagementClinical Decision-MakingBehavioral Health Care ManagementEvidence-Based Criteria ApplicationDocumentation AccuracyQuality Improvement InitiativesCritical ThinkingInformed Decision-MakingBehavioral Health Clinical ExperienceHealth Insurance Knowledge

Soft Skills

Exceptional Customer ServiceOrganizational SkillsTime ManagementInterpersonal CommunicationProfessional Communication

Tools & Technologies

Electronic Healthcare Documentation SystemsMicrosoft OfficeOutlookInternet Search Capabilities

Certifications & Qualifications

Unrestricted Clinical LicenseLicensed in WA, OR, ID or UT

Industry Keywords

Behavioral HealthClinical ExpertiseTransitions of CareConfidential Information ProtectionRegulatory Compliance

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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