Remote Appeals Clinician I (RN)

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

Benefits offered by this job

Medical, dental and vision coverage

401(k) with company match

Paid time off & holidays

Parental leave

Job summary

Cambia Health in the United States is seeking an Appeals Clinician I to join the Clinical Services team. You will apply nursing expertise to complete the clinical component of all appeal types to resolve member and/or provider appeals, all in support of easier health journeys.

As an RN with clinical experience you will assess records, interpret medical data, and communicate findings clearly to clinicians and non-clinical staff.

Qualifications

• Bachelor's Degree in Nursing and 3 years of clinical or health insurance experience.
• Active RN license in OR, WA, ID or UT.
• Ability to conduct independent clinical assessments and communicate complex topics.

Responsibilities

• Apply nursing expertise to ensure written appeal decisions comply with policy.
• Conduct clinical appeal reviews and advise non-clinical staff as needed.
• Consult with physician advisers to support clinically appropriate determinations.

Skills

Nursing

Clinical review

Medical policy

CPT/ICD coding

MCG knowledge

AI tools familiarity

Communication

Data interpretation

Education

Bachelor's Degree in Nursing

Tools

Microsoft Word

Excel

PowerPoint

Access

Job description

Cambia Health in the United States is seeking an Appeals Clinician I to join the Clinical Services team. You will apply nursing expertise to complete the clinical component of all appeal types to resolve member and/or provider appeals, all in support of easier health journeys.

As an RN with clinical experience you will assess records, interpret medical data, and communicate findings clearly to clinicians and non-clinical staff.