Remote Appeals Clinician I – RN Advocate

Cambia Health Solutions

Utah

Remote

USD 48,000 - 79,000

Full time

9 days ago

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Benefits offered by this job

Medical, dental and vision coverage

Health savings account

Generous paid time off

Retirement plan with company match

Parental leave

Wellness programs

Employee Assistance Fund

Job summary

Cambia Health Solutions is seeking an Appeals Clinician I to work from home across Oregon, Washington, Idaho or Utah. You will apply nursing expertise to resolve member and provider appeals, ensuring medical policy alignment and appropriate determinations.

The role emphasizes collaboration with physician advisers and educating non-clinical staff, leveraging experience in clinical care, coding, and claims review to drive outcomes.

Qualifications

Bachelor's Degree in Nursing with 3 years in clinical settings or equivalent.
Active RN license in OR/WA/ID/UT with unrestricted practice.
Experience in claim review, coding knowledge and policy compliance.

Responsibilities

Apply nursing judgement to ensure decisions align with medical policy and reimbursement rules.
Conduct clinical appeal reviews in line with member benefits and contracts.
Consult with physician advisers to confirm appropriate determinations.
Educate non-clinical staff on clinical cases.

Skills

Clinical nursing expertise

RN license (Utah/Washington/Idaho/Oreg

Billing and claims familiarity

MCG/CPT/ICD coding knowledge

Communication of complex topics

Proficiency in MS Office (Word/Excel/P

Education

Bachelor's Degree in Nursing

Tools

Microsoft Word

Excel

PowerPoint

Access

Job description

The role emphasizes collaboration with physician advisers and educating non-clinical staff, leveraging experience in clinical care, coding, and claims review to drive outcomes.

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