Remote Appeals Clinician I (RN)

Cambia Health; Coeur d'Alene (ID); Remote; USD 51,000 - 69,000; Full time

Benefits offered by this job

Medical/dental/vision coverage

HSA contributions

Paid time off

401(k) with company match

Parental leave

Wellness programs

Employee assistance fund

Commuter benefits

Job summary

Cambia Health is seeking an Appeals Clinician I to work from home across Oregon, Washington, Idaho or Utah. You will apply nursing expertise to complete clinical reviews for various appeals to support members and providers, while ensuring policy compliance. 

The role emphasizes collaboration with physician advisers, clear written decisions, and ongoing education of non-clinical staff. BSN and an active RN license with 3 years of clinical experience are required.

Qualifications

• Bachelor's Degree in Nursing and 3 years of clinical experience in health insurance or related fields.
• Active RN license in OR, WA, ID or UT.
• Experience with coding/claims review and case management is preferred.

Responsibilities

• Complete clinical reviews for all appeal types while following policy and guidelines.
• Consult with physicians to ensure appropriate determinations when needed.
• Educate non-clinical staff on clinical cases and maintain clear documentation.

Skills

RN license

BSN

Clinical experience

Billing/claims review

Coding knowledge

Medical policy interpretation

AI tools

Education

Bachelor's Degree in Nursing

Tools

Microsoft Word

Excel

PowerPoint

Access

Job description

Cambia Health is seeking an Appeals Clinician I to work from home across Oregon, Washington, Idaho or Utah. You will apply nursing expertise to complete clinical reviews for various appeals to support members and providers, while ensuring policy compliance. 

The role emphasizes collaboration with physician advisers, clear written decisions, and ongoing education of non-clinical staff. BSN and an active RN license with 3 years of clinical experience are required.