Remote Appeals Clinician I – RN Health Advocate

Cambia Health; Lewiston (ID); Remote; USD 51,000 - 69,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Health savings account contributions

Paid time off and holidays

Job summary

Cambia Health is seeking an Appeals Clinician I to work remotely from within Oregon, Washington, Idaho or Utah. The role centers on applying nursing expertise to complete clinical components of appeals and resolve member/provider cases, improving health journeys.

The ideal candidate holds a Bachelor’s in Nursing with 3 years of clinical experience, an active RN license, and strong skills in medical policy interpretation and clear written communication.

Qualifications

• Bachelor's Degree in Nursing and 3 years of experience in a clinical setting, health insurance, coding/claims review, case management or equivalent combination of education and experience.
• Active RN licensure in a U.S. state or territory (Oregon, Washington, Idaho or Utah) with current valid status.
• Experience reading and interpreting medical records and communicating complex topics to clinical and non-clinical staff.

Responsibilities

• Applies nursing expertise and clinical judgement to ensure written appeal decisions comply with medical policy and guidelines.
• Conducts clinical appeal reviews in alignment with member benefits and contracts.
• Consults with physician advisers to ensure clinically appropriate determinations when required.
• Advises and educates non-clinical appeals staff on clinical cases.

Skills

Nursing licensure

Clinical decision making

Medical policy application

Communication skills

Education

Bachelor's Degree in Nursing

Tools

Microsoft Word

Excel

PowerPoint

Access

Job description

Cambia Health is seeking an Appeals Clinician I to work remotely from within Oregon, Washington, Idaho or Utah. The role centers on applying nursing expertise to complete clinical components of appeals and resolve member/provider cases, improving health journeys.

The ideal candidate holds a Bachelor’s in Nursing with 3 years of clinical experience, an active RN license, and strong skills in medical policy interpretation and clear written communication.