Behavioral Health Utilization Management Clinical Support Specialist
Cambia Health Solutions
Spokane, WA
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JOB DETAILS
JOB TYPE
Full-time, Employee
SKILLS
Administrative Skills, Artificial Intelligence (AI), Behavioral Health, Billing Records, Clinical Support, Clinical Validation, Communication Skills, Computer Skills, Current Procedural Terminology (CPT), Customer Support/Service, Data Entry, Diagnostic and Statistical Manual of Mental Disorders (DSM), Discharge Plans, Electronic Medical Records, Establish Priorities, Health Economics, Healthcare, Healthcare Common Procedure Coding System (HCPCS), Healthcare Providers, Internet Search, Medical Records, Mentoring, Microsoft Office, Microsoft Outlook, Organizational Skills, Outpatient Care, Patient Care, Presentation/Verbal Skills, Problem Solving Skills, Psychiatry and Mental Health, Quality Metrics, Regulations, Regulatory Compliance, Social Work, Systems Maintenance, Team Player, Time Management, Training/Teaching, Utilization Management, Work From Home, Writing Skills
LOCATION
Spokane, WA
POSTED
30+ days ago
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.
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 s
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About the Company
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Cambia Health Solutions
Cambia Health Solutions is a family of companies headquartered in Portland, Oregon, working to create a person-focused and economically sustainable health care system.
Through our health plans, innovative technology and strategic investments, we are delivering consumer-centric solutions that:
• help people achieve better health and well-being
• make health care more available, affordable and accessible
• are easily understood by everyone
We put people at the heart of everything we do. Our company reaches more than 70 million Americans nationwide, including more than two million people in the Pacific Northwest who are enrolled in our regional health plans.
COMPANY SIZE
5,000 to 9,999 employeesINDUSTRY
Healthcare Services
FOUNDED
1940
WEBSITE
https://www.cambiahealth.com/careers