Cvs Health Utilization Management Remote Jobs (NOW HIRING)

This is a part-time non-benefited position with a maximum of 12 hours per week.

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 team of physicians are living our mission to make health care easier and lives better. As a member of the Utilization Management (UM) team, our Associate Medical Director BH and UM Medical Directors provides leadership, and clinical oversight for behavioral health operations across all lines of business within the health plan, with a primary focus on behavioral health utilization management. Partners with leaders and staff across the organization to ensure policies, programs and strategies related to our members. Conducts case reviews requiring physician involvement and/or provides clinical expertise to others related to behavioral health case management, prior authorizations and appeals. Provides peer-to-peer consultations with providers - all in service of creating a person-focused health care experience.

Are you a motivated and experienced medical professional looking for a new challenge? Do you have a passion for patient care and want to make a big difference in healthcare? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Licensed Physician with an MD or DO degree

• Active, unrestricted license to practice medicine in one or more of our 4 states.

• Board Certification in general psychiatry or child psychiatry required with preference for being board certified in both.

• Qualification by training and experience to render clinical opinions about medical conditions, procedures, and treatments under review.

• At least 3 years clinical experience.

• Two years health plan medical utilization management and/or case management experience.

• Equivalent combination of education and experience.

• Must be located in one of our four states.

Skills and Attributes:

• In-depth knowledge of best practices related to medical care for a wide variety of behavioral health conditions.

• Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to effectively manage patient care to improve outcomes.

• Passion for population health, healthcare transformation and improving the experience of people with mental health issues.

• Strong communication and facilitation skills with internal staff and external stakeholders, including the ability to resolve issues and seek optimal outcomes.

• Proven ability to develop and maintain positive working relationships with community and provider partners.

• Knowledge of the health insurance industry, state and federal regulations (including Parity Legislation/Regulations), provider reimbursement methods and evolving accountable care and payment models is preferred.

• Experience conducting medical case reviews for utilization and/or case management is strongly preferred.

• Detail-oriented with orientation to the application of data and metrics in managing health, quality and program effectiveness.

• Leadership experience with demonstrated ability to effectively build relationships, work with others and lead people and project teams.

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:

• Completes Behavioral Health utilization management reviews, including PA, appeals and post-service.

• Develops and Implements Behavioral Health Policies and Programs: Assists in developing high-quality, market-competitive behavioral health medical policies and programs, and provides leadership in developing short and long-range plans, goals, and objectives for integrated utilization management.

• Operational Leadership and Oversight: Oversees the development of effective operational policies, procedures, and standards for an integrated behavioral health program, monitors utilization and results, and implements process or system changes as needed.

• Subject Matter Expert and Clinical Leadership: Serves as a subject matter expert on behavioral health, provides medical advice, oversight, and leadership for staff, and ensures members receive safe, effective, and cost-efficient services.

• Collaboration and Communication: Collaborates with the Executive Medical Director of Behavioral Health, leads/participates in teams for medical policy reviews and development, and discusses review determinations with providers to promote understanding of utilization management and quality improvement policies.

• Industry Trends and Opportunities: Stays abreast of industry, medical, and technology trends, identifies and communicates new opportunities to enhance outcomes and the organization's reputation, and collaborates to implement actions to reduce medical cost trend.

• Other roles as assigned.

#LI-Remote

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.

Associate Medical Director

• Oregon, Washington, Utah, and Idaho:The expected hiring range is$217,600 - $294,400, the full salary range is$204,000 - $333,000 and the bonus target is25%.

• North Dakota:The expected hiring range is$217,171.97 - $293,820.91 and the full salary range is$192,827.15 - $318,165.72.

Medical Director

• Oregon, Washington, Utah, and Idaho:The expected hiring range is$238,850 - $323,150, the full salary range is$224,000 - $366,000 and the bonus target is30%.

• North Dakota:The expected hiring range is$252,506.91 - $341,626.99, the full salary range is$224,201.29 - $369,932.61 and the bonus target is20%.

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?

At Cambia, you can:

• 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.

We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

• 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.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.