Remote Appeals Clinician I: RN Advocate for Members

Cambia Health; Bend (OR); Remote; USD 48,000 - 79,000; Full time

Benefits offered by this job

Health, dental and vision coverage

Health Savings Account

Paid time off

Retirement plan with company match

Parental leave

Wellness programs

Employee Assistance Fund

Commute and parking benefits

Job summary

Cambia Health Solutions is seeking an Appeals Clinician I, remote within Oregon, Washington, Idaho or Utah. The role uses nursing expertise to resolve member and provider appeals, ensuring compliance with medical policy and guidelines.

Ideal candidates are registered nurses with an active license in OR/WA/ID/UT and at least 3 years of direct clinical care. Collaboration with physicians and education of non-clinical staff are key aspects of the position.

Qualifications

• Bachelor's Degree in Nursing and 3 years of clinical experience including health insurance, coding/claims review, case management, or equivalent.
• Active RN license in OR, WA, ID or UT or eligible in those states.

Responsibilities

• Provide clinical assessments to complete the clinical component of all appeal types.
• Ensure decisions comply with medical policy and reimbursement guidelines.
• Consult with physician advisers to ensure clinically appropriate determinations when required.

Skills

Claim review

Medical policy

CPT/ICD coding

Communication

Clinical decision making

Education

Bachelor's Degree in Nursing

Tools

Microsoft Word

Excel

PowerPoint

Access

Job description

Cambia Health Solutions is seeking an Appeals Clinician I, remote within Oregon, Washington, Idaho or Utah. The role uses nursing expertise to resolve member and provider appeals, ensuring compliance with medical policy and guidelines.

Ideal candidates are registered nurses with an active license in OR/WA/ID/UT and at least 3 years of direct clinical care. Collaboration with physicians and education of non-clinical staff are key aspects of the position.