Remote Appeals Clinician I – RN Guiding Care Decisions

Cambia Health; Beaverton (OR); Remote; USD 48.000 - 79.000; Vollzeit

Benefits dieser Stelle

Medical, dental and vision coverage

Health savings account

Paid time off

Retirement plan with company match

Parental leave

Wellness programs

Zusammenfassung

Cambia Health is seeking an Appeals Clinician I to work from home within Oregon, Washington, Idaho or Utah. You will apply nursing expertise to ensure appeal decisions align with medical policy and guidelines, while supporting education for non-clinical staff.

The role involves conducting clinical appeal reviews, consulting with physician advisers, and advising on clinical cases to drive patient-centered outcomes.

Qualifikationen

• Bachelor's Degree in Nursing and 3 years of clinical experience in health insurance, coding/claims review, case management or equivalent.
• Active RN license in OR/WA/ID/UT with current unrestricted status.
• Ability to interpret medical records and communicate complex topics to clinical and non-clinical staff.

Aufgaben

• Apply nursing expertise and clinical judgement to ensure written appeal decisions comply with medical policy and related guidelines.
• Conduct clinical appeal reviews in line with member benefits and provider contracts.
• Consult with physician advisers to ensure clinically appropriate determinations when required.
• Advise and educate non-clinical appeals staff on clinical cases.

Kenntnisse

Clinical assessment

Communication of complex topics

Policy compliance

Team collaboration

Ausbildung

Bachelor's Degree in Nursing

Tools

Microsoft Word

Excel

PowerPoint

Access

Jobbeschreibung

Cambia Health is seeking an Appeals Clinician I to work from home within Oregon, Washington, Idaho or Utah. You will apply nursing expertise to ensure appeal decisions align with medical policy and guidelines, while supporting education for non-clinical staff.

The role involves conducting clinical appeal reviews, consulting with physician advisers, and advising on clinical cases to drive patient-centered outcomes.