Remote Appeals Clinician I - RN

Cambia Health Solutions; United States; Teletrabalho; USD 72 000 - 118 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical, dental and vision coverage

401(k) with company match

Paid time off

12 company holidays

Parental leave

Wellness programs

Resumo da oferta

Cambia Health Solutions is seeking an Appeals Clinician I to join our Clinical Services team. This role conducts clinical reviews of member and provider appeals, applying nursing expertise to determine decisions in line with medical policy and regulations.

You will collaborate with physician advisers and educate non-clinical staff on clinical cases, supporting patients’ access to quality care. The position supports a remote work model across Oregon, Washington, Idaho, and Utah, with preference

Qualificações

• Bachelor’s Degree in Nursing and 3 years of experience in a clinical setting, health insurance, coding/claims review, case management or equivalent combination of education and experience.
• Active licensure in a US state/territory and at least 3 years of direct clinical care.
• Registered nurse (RN) license with current unrestricted status in OR, WA, ID or UT.

Responsabilidades

• Applies nursing expertise and clinical judgement to ensure written appeal decisions are in compliance with medical policy and guidelines.
• Conducts clinical appeal reviews adhering to member benefits and provider/hospital contracts.
• Consults with physician advisers to ensure clinically appropriate determinations when required.
• Advises and educates non-clinical appeals staff on clinical cases.

Conhecimentos

Claim review

Medical coding

RN licensure

Clinical assessment

Medical records review

Microsoft Office

Policy compliance

AI tools

Communication

Formação académica

Bachelor’s Degree in Nursing

Ferramentas

Microsoft Word

Microsoft Excel

PowerPoint

Access

Descrição da oferta de emprego

Cambia Health Solutions is seeking an Appeals Clinician I to join our Clinical Services team. This role conducts clinical reviews of member and provider appeals, applying nursing expertise to determine decisions in line with medical policy and regulations.

You will collaborate with physician advisers and educate non-clinical staff on clinical cases, supporting patients’ access to quality care. The position supports a remote work model across Oregon, Washington, Idaho, and Utah, with preference