Remote Appeals Clinician I – RN

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

Benefits offered by this job

Health benefits

Retirement plan

Paid time off

Parental leave

Job summary

Cambia Health is seeking an Appeals Clinician I to work remotely from the United States. The role focuses on reviewing clinical components of various appeals, applying nursing expertise, and ensuring decisions align with medical policy and reimbursement rules.

The ideal candidate holds a Bachelor’s in Nursing, an active RN license, and several years of clinical experience, with familiarity in coding, claims review, or case management.

Qualifications

• Bachelor's Degree in Nursing and 3 years in a clinical setting or related area.
• Active RN license in a state within the United States with no restrictions.
• Experience in health insurance, coding/claims review, or case management.

Responsibilities

• Applies nursing expertise and clinical judgement to ensure written appeal decisions comply with medical policy and related guidelines.
• Conducts clinical appeal reviews in line with member benefits and contracts.
• Consults with physician advisers to ensure clinically appropriate determinations.

Skills

Clinical decision making

RN licensure

Healthcare claim review

MS Office

AI tools

Education

Bachelor's Degree in Nursing

Tools

MS Office

AI tools

Job description

Cambia Health is seeking an Appeals Clinician I to work remotely from the United States. The role focuses on reviewing clinical components of various appeals, applying nursing expertise, and ensuring decisions align with medical policy and reimbursement rules.

The ideal candidate holds a Bachelor’s in Nursing, an active RN license, and several years of clinical experience, with familiarity in coding, claims review, or case management.