Care Management Behavioral Health Specialist

About the Role

Join our Cause to create a person-focused and economically sustainable health care system. As a member of the Care Management team, our Care Management Behavioral Health Specialist provides clinical care management (such as case management, disease management, and/or care coordination) to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes.

Oversees a collaborative process with the member and those involved in the member’s care to assess, plan, implement, coordinate, monitor, and evaluate care as needed—all in service of making our members’ health journeys easier.

Responsibilities

• Collect in-depth information about member situations and functioning to identify individual needs, then develop specific objectives, goals, and actions to address those needs.
• Execute case management activities while organizing, securing, integrating, and modifying resources to accomplish established goals.
• Gather information to determine plan effectiveness and measure success in reaching desired outcomes.
• Apply clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care using evidence-based criteria that incorporates current and validated clinical research findings.
• Practice within scope of license and consult with physician advisors to ensure clinically appropriate determinations.
• Serve as a resource to internal and external customers, collaborate with other departments to resolve claims, quality of care, member or provider issues, and respond professionally to members, providers, and regulatory organizations while protecting confidentiality.
• Identify problems or needed changes, recommend resolutions, participate in quality improvement efforts, and provide consistent, accurate documentation.
• Plan, organize, and prioritize assignments to comply with performance standards, corporate goals, and established timelines.

Requirements

• Associate or Bachelor’s Degree in Nursing, Behavioral Health, or related field.
• 3 years of case management, utilization management, disease management, or behavioral health case management experience or equivalent combination of education and experience.
• 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 as permitted within the scope of practice for the discipline (e.g., medical vs. behavioral health) and at least 3 years (or full-time equivalent) of direct clinical care.

Skills

• 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.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.
• Strong oral, written, and interpersonal communication and customer service skills.
• Ability to communicate complex topics effectively.
• Strong organization and time management skills with the ability to manage workload independently.
• Ability to think critically and make decisions within individual role and responsibility.

Pay

Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure/certifications; and performance history.

• Oregon, Washington, Utah, and Idaho: The expected hiring range is $36.80 – $49.80 an hour, the full salary range is $34.20 – $55.70 an hour, and the bonus target is 10%.

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.

Schedule

This role offers work from home options for most locations. Requirements include:

• A wired internet connection that is not satellite or cellular.
• Internet service with a minimum upload speed of 5Mb and a minimum download speed of 10Mb.
• Access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company.

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?

• 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.