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.

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.

• 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.

• 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

• 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

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