Remote Appeals Clinician I – RN Advocate for Patients

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

Job summary

Cambia Health is seeking an Appeals Clinician I to work remotely from home within Oregon, Washington, Idaho or Utah. You will apply nursing expertise to complete the clinical component of all appeal types, resolving member and provider appeals with a focus on patient-centered outcomes.

The role requires a Bachelor's Degree in Nursing and an active RN license in one of the eligible states, plus 3 years of direct clinical care.

Qualifications

• Bachelor's Degree in Nursing and 3 years of clinical experience or equivalent.
• Active RN license in OR/WA/ID/UT or eligible territory.
• Experience with medical policy, coding or claims review is preferred.

Responsibilities

• Apply nursing expertise to ensure appeal decisions comply with medical policy and reimbursement rules.
• Conduct clinical appeal reviews and consult with physicians as needed.
• Educate non-clinical staff on clinical cases and decisions.

Skills

Clinical assessment

Policy knowledge

Communication

Medical coding awareness

Education

Bachelor's Degree in Nursing

Tools

CPT/ICD coding knowledge

Medical records review

Job description

Cambia Health is seeking an Appeals Clinician I to work remotely from home within Oregon, Washington, Idaho or Utah. You will apply nursing expertise to complete the clinical component of all appeal types, resolving member and provider appeals with a focus on patient-centered outcomes.

The role requires a Bachelor's Degree in Nursing and an active RN license in one of the eligible states, plus 3 years of direct clinical care.