Care Management Behavioral Health Specialist

This is a fully remote position, open to applicants in Idaho, +3 more states.

📋 Description

• Deliver clinical care management, which encompasses case management, disease management, and/or care coordination.

• Supervise a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate member care.

• Gather comprehensive information regarding member circumstances and functioning to identify needs.

• Formulate objectives, goals, and actions to address the needs of the members.

• Carry out case management activities and organize, secure, integrate, and adjust resources as necessary.

• Collect data to evaluate the effectiveness of plans and measure outcomes.

• Utilize clinical expertise and judgment to ensure adherence to medical policy, medical necessity guidelines, and standards of care.

• Implement evidence-based criteria that incorporate current and validated clinical research.

• Operate within the scope of license and consult with physician advisors for clinically appropriate determinations.

• Act as a resource for both internal and external customers.

• Collaborate with various departments to address claims, quality-of-care, member, or provider concerns.

• Respond professionally to members, providers, and regulatory organizations while maintaining confidentiality.

• Identify issues or necessary changes and propose solutions.

• Engage in quality improvement initiatives.

• Maintain consistent and accurate documentation.

• Plan, organize, and prioritize tasks to meet performance standards, corporate objectives, and deadlines.

⛳️ Requirements

• Associate or Bachelor’s Degree in Nursing, Behavioral Health, or a related field.

• Three years of experience in case management, utilization management, disease management, or behavioral health case management, or an equivalent combination of education and experience.

• Must possess licensure or certification in a state or territory of the United States, in a health or human services discipline that allows for independent assessment within the scope of practice.

• At least three years (or full-time equivalent) of direct clinical care experience.

• Understanding of trends in the health insurance industry, technology, and contractual agreements.

• Proficient in general computer skills, including Microsoft Office, Outlook, and internet search capabilities.

• Familiarity with healthcare documentation systems.

• Ability to interpret policies and procedures effectively.

• Experience with AI tools and technologies is highly desirable.

• Excellent oral, written, interpersonal communication, and customer service abilities.

• Capability to convey complex topics clearly.

• Strong organizational and time management skills; ability to manage workload autonomously.

• Critical thinking skills and the ability to make decisions within the scope of individual responsibilities.

• Personal mobile device required for Multi-Factor Authentication (MFA).

• A wired internet connection is necessary; not satellite or cellular; with a minimum of 5Mb upload and 10Mb download speed.

• Background check is mandatory.

🏝️ Benefits

• Competitive base salary.

• Leading market 401(k) plan with a substantial company match.

• Bonus opportunities with a target of 10%.

• 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, varying by role and length of service.

• Ten company-paid holidays.

• Market-leading retirement plan with a company match and potential discretionary contributions based on company performance; no vesting period.

• Up to 12 weeks of paid parental leave after 12 months of continuous service.

• Award-winning wellness programs that incentivize participation.

• Employee Assistance Fund.

• Benefits for commuting and parking.

• Options to work from home.

• Support for wired internet requirements for remote work.

• Employee resource groups.

• Cambia-supported community outreach initiatives.