Care Management Behavioral Health Specialist
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Behavioral Health Specialist managing clinical care and outcomes for Cambia’s person-focused health care system. Coordinating resources, assessments, and evidence-based interventions for members.
Responsibilities:
- Provide clinical care management, including case management, disease management, and/or care coordination
- Oversee a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate member care
- Collect in-depth information about member situations and functioning to identify needs
- Develop objectives, goals, and actions to address member needs
- Execute case management activities and organize, secure, integrate, and modify resources
- Gather information to determine plan effectiveness and measure outcomes
- Apply clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and standards of care
- Use evidence-based criteria incorporating current and validated clinical research
- Practice within scope of license and consult physician advisors for clinically appropriate determinations
- Serve as a resource to internal and external customers
- Collaborate with departments to resolve claims, quality-of-care, member, or provider issues
- Respond professionally to members, providers, and regulatory organizations while protecting confidentiality
- Identify problems or needed changes and recommend resolutions
- Participate in quality improvement efforts
- Provide consistent, accurate documentation
- Plan, organize, and prioritize assignments to meet performance standards, corporate goals, and 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 independent assessment within the scope of practice
- At least 3 years (or full-time equivalent) of direct clinical care
- Knowledge of health insurance industry trends, technology, and contractual arrangements
- General computer skills, including Microsoft Office, Outlook, and internet search
- Familiarity with health care documentation systems
- Ability to interpret policies and procedures
- Experience with AI tools and technologies highly desired
- Strong oral, written, interpersonal communication, and customer service skills
- Ability to communicate complex topics effectively
- Strong organization and time management skills; ability to manage workload independently
- Ability to think critically and make decisions within individual role and responsibility
- Personal mobile device required for MFA
- Wired internet connection required; not satellite or cellular; minimum 5Mb upload and 10Mb download
- Background check required
Benefits:
- Competitive base pay
- Market-leading 401(k) with a significant company match
- Bonus opportunities; 10% bonus target
- 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 tenure
- 10 company-paid holidays
- Market-leading retirement plan with company match and potential discretionary contribution based on company performance; 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 requirement support for remote work
- Employee resource groups
- Cambia-supported community outreach programs
Similar Jobs
Global Site Identification and Feasibility Specialist – Sponsor-Dedicated
Global Site Identification and Feasibility Specialist supporting Syneos Health’s sponsor-dedicated clinical trials. Identifying high-performing sites and providing data-driven enrollment and study-planning insights.
Production Specialist
Production Specialist managing branded merchandise and corporate gifting projects for Brilliant. Coordinating suppliers, creative teams, purchase orders, timelines, and final delivery.
Direct Support Professional – ASL
Direct Support Professional providing ASL-enabled in-home and community care for individuals with intellectual and developmental disabilities. Supporting routines, independence, emotional regulation, and community access in Beaverton.
Senior Comms Production Specialist, Membership & Incentives
Senior specialist delivering high-volume Salesforce loyalty communications for Blueprint, a technology solutions firm. Owning campaign builds, QA, launches, monitoring, and issue resolution across email and push.
Part Time Unmanned Aircraft System (UAS) Subject Matter Expert
UAS subject matter expert supporting Culmen International, a government mission and security services company. Developing training, doctrine, deployability, and maritime ISR readiness for OCONUS engagements.
Monitoring & Evaluation Specialist
Monitoring & Evaluation Specialist at Tiko, an African nonprofit connecting young women to healthcare services and rewards. Building evidence frameworks, analyzing program data, and improving health-program impact across Nigeria and South Africa.
Donation Support Services Coordinator
Donation Support Services Coordinator facilitating organ, eye, and tissue donation for Lifeline of Ohio. Coordinating referrals, donor authorization, medical evaluations, family support, and recovery logistics.
Product Deployment Specialist
Product Deployment Specialist scaling Flock’s drone and robotics rollouts for safer communities. Building field-tested installation processes, deployment playbooks, and operational readiness frameworks.
Research Interventionalist
Vanderbilt University research recruiter engaging Chinese, Japanese, and Korean communities in nursing studies. Developing culturally appropriate campaigns, translations, partnerships, and participant recruitment records.
Infection Prevention Specialist – Vascular
Solventum healthcare sales specialist managing vascular products across South Carolina accounts. Achieving sales objectives through independent territory and account coverage.
Auto Litigation Specialist
Auto Litigation Specialist resolving complex towing, storage, relocation, and lien disputes for Allstate Canada’s insurance claims operations. Negotiating cost-effective outcomes and supporting litigation processes.
Accreditation Specialist
Accreditation Specialist improving clinical quality and accreditation readiness for Centene, a healthcare solutions provider. Coordinating NCQA, HEDIS, delegation oversight, audits, and corrective action plans.
Hospitality Coordinator, Global Dining
Hospitality Coordinator supporting Tock, American Express’s restaurant SaaS platform, through technical customer service. Troubleshooting issues, managing escalations, and delivering virtual training.
Accreditation Review Specialist – Procedural
Accreditation reviewer helping healthcare facilities earn cardiovascular certifications from the American College of Cardiology. Conducting site reviews, analyzing compliance, and reporting improvement opportunities.
Exercise Specialist
Exercise Specialist designing virtual and in-person strength and conditioning programs for University of Rochester clients. Coaching teams and individuals while measuring training progress and expanding fitness services.
Labour Market Information Specialist
Labour Market Information Specialist analyzing Canadian employment data for WCG. Producing research, visualizations, and reports supporting employment-services operations and growth.
Banking Specialist III
Banking Specialist III servicing electronic security, intrusion, video, and life safety systems for Convergint, a global systems integrator. Installing, programming, troubleshooting, repairing, and supporting customer projects.
Digital Solutions Integration Specialist – Austria/Switzerland
Digital Solutions Integration Specialist supporting Intuitive Hub and MyIntuitive+ adoption for Austrian and Swiss healthcare customers. Delivering clinical integrations, workflow optimization, training, troubleshooting, and digital solution expansion.
Shopfloor Team Member
Shopfloor Team Member supporting The Warehouse Group’s retail operations in Waipapa. Restocking shelves, serving customers, cleaning stores, and fulfilling online orders.
Proposal Specialist
Proposal Specialist supporting HubSpot, an AI-powered customer platform, with enterprise proposals and RFP responses. Partnering across sales, legal, marketing, and technical teams to deliver accurate buyer narratives.