Remote Appeals Clinician I — Advocate for Members

Cambia Health Solutions, Inc.; Washington (UT); Hybrid; USD 51,000 - 69,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Health savings account (HSA)

Paid time off and holidays

401(k) with company match

Job summary

Cambia Health Solutions, Inc. is seeking an Appeals Clinician I to perform clinical reviews for appeals from members and providers. The role supports the Clinical Services team and emphasizes nursing judgment to ensure policy-aligned decisions.

The position is remote, with preference for candidates residing in Idaho or Utah, and requires RN licensure in OR, WA, ID or UT, plus 3 years of clinical experience and familiarity with coding/claims review.

Qualifications

• Bachelor's Degree in Nursing and 3+ years in a clinical setting, health insurance, coding/claims review, or case management.

Responsibilities

• Apply nursing expertise to ensure decisions comply with medical policy and guidelines.
• Conduct clinical appeal reviews in line with member benefits and contracts.
• Consult with physician advisers for clinically appropriate determinations when required.
• Educate non-clinical appeals staff on clinical cases and documentation.

Skills

Claim review

Medical policy

CPT/ICD coding

AI tools

Microsoft Office

Education

Bachelor's Degree in Nursing

RN license (active)

Tools

Microsoft Word

Excel

PowerPoint

Access

Job description

Cambia Health Solutions, Inc. is seeking an Appeals Clinician I to perform clinical reviews for appeals from members and providers. The role supports the Clinical Services team and emphasizes nursing judgment to ensure policy-aligned decisions.

The position is remote, with preference for candidates residing in Idaho or Utah, and requires RN licensure in OR, WA, ID or UT, plus 3 years of clinical experience and familiarity with coding/claims review.