Remote Appeals Clinician I (RN)

Cambia Health; Bellevue (WA); Remote; USD 48,000 - 79,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Health Savings Account

Paid time off

401(k) with company match

Parental leave

Wellness programs

Employee Assistance Fund

Commuting and parking benefits

Job summary

Cambia Health is seeking an Appeals Clinician I to work from home within Oregon, Washington, Idaho or Utah. You’ll apply nursing expertise to complete the clinical component of appeals and help resolve member and provider cases.

You’ll consult with physicians, ensure decisions follow medical policy and regulations, and educate non‑clinical staff on clinical matters. A BSN and 3+ years of direct clinical experience with RN licensure are required.

Qualifications

• Bachelor's degree in nursing and RN license.
• Active US state licensure and at least 3 years of direct clinical care.
• Experience in claims review and knowledge of medical policy.

Responsibilities

• Applies nursing expertise to ensure written appeal decisions comply with medical policy and regulations.
• Conducts clinical appeal reviews in line with member benefits and contracts; consults with physician advisers.
• Educates non-clinical staff on clinical cases and processes.

Skills

Claim review

Medical procedures knowledge

Medical policy compliance

Medical records interpretation

CPT/ICD coding knowledge

Microsoft Word

AI tools familiarity

Clinical communication

Education

Bachelor's Degree in Nursing

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Access

Job description

Cambia Health is seeking an Appeals Clinician I to work from home within Oregon, Washington, Idaho or Utah. You’ll apply nursing expertise to complete the clinical component of appeals and help resolve member and provider cases.

You’ll consult with physicians, ensure decisions follow medical policy and regulations, and educate non‑clinical staff on clinical matters. A BSN and 3+ years of direct clinical experience with RN licensure are required.