Remote Appeals Clinician I – RN Advocate for Patients

Cambia Health; Vancouver (WA); Remote; USD 51,000 - 69,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Health savings account

Generous paid time off

Job summary

Cambia Health is seeking an Appeals Clinician I who can work remotely within Oregon, Washington, Idaho or Utah. This role focuses on applying nursing expertise to write and review clinical appeal decisions, ensuring alignment with medical policies and reimbursement rules.

The position supports member and provider appeals with guidance from physician advisers. The candidate should hold an RN license in WA/OR/ID/UT, have 3+ years of clinical experience, and be proficient in medical coding, CPT/ICD

Qualifications

• Bachelor's degree in nursing and 3+ years of clinical experience in health insurance, coding/claims review, or case management.
• Active RN license in WA/OR/ID/UT or able to obtain, with current unrestricted license.
• Experience applying clinical expertise to medical policy and appeals processes.

Responsibilities

• Apply nursing expertise to ensure written appeal decisions meet medical policy and reimbursement standards.
• Conduct clinical appeal reviews and consult with physician advisers as needed.
• Educate non-clinical staff on clinical cases and provide guidance on complex determinations.

Skills

Clinical review

Medical coding

RN licensure

Policy interpretation

Communication

AI tools

Education

Bachelor's Degree in Nursing

Tools

Microsoft Word

Excel

PowerPoint

Access

Job description

Cambia Health is seeking an Appeals Clinician I who can work remotely within Oregon, Washington, Idaho or Utah. This role focuses on applying nursing expertise to write and review clinical appeal decisions, ensuring alignment with medical policies and reimbursement rules.

The position supports member and provider appeals with guidance from physician advisers. The candidate should hold an RN license in WA/OR/ID/UT, have 3+ years of clinical experience, and be proficient in medical coding, CPT/ICD