Remote Clinical Operations Specialist - UM & Docs

Cambia Health; Salt Lake City (UT); Remote; USD 33,000 - 59,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off and holidays

Retirement plan with company match

Job summary

Cambia Health is seeking a Clinical Specialist to support utilization management processes with strong clinical knowledge and data-management skills. You will review requests, obtain missing information, and prepare cases for clinical review while handling nonclinical tasks to free up nursing staff.

Responsibilities include outreach to providers, documentation, and ensuring compliance with regulatory and quality requirements, with work-from-home options across multiple Western states.

Qualifications

• Clinical experience in hospital or health plan setting.
• Strong oral and written communication skills.
• Ability to work in a fast-paced environment with accuracy and confidentiality.
• Proficient in Microsoft Office, Outlook, internet research; familiarity with health care systems and documentation (EMR, billing, claims).
• Knowledge of medical terminology, anatomy and coding (CPT, DX, HCPCS).
• Strong organizational, data entry, and administrative skills.
• Ability to investigate complex UM cases and collaborate with clinical staff.
• Ability to work independently and in teams; meet deadlines.
• Willingness to mentor teammates and train new staff.
• Experience with AI tools desirable.

Responsibilities

• Research simple to moderately complex UM requests and related documentation.
• Review requests for completeness and prepare cases for clinical review.
• Complete nonclinical case tasks and document key information.
• Contact providers to request medical records and communicate determinations.
• Meet departmental timeliness, production, quality, and regulatory standards.

Skills

Clinical experience

Communication

Computer skills

EMR systems

Medical terminology

Data entry

Teamwork

Research

Mentoring

AI tools

Education

High school diploma or equivalent

LPN/CMA/CNA preferred

Tools

Microsoft Office

Job description

Cambia Health is seeking a Clinical Specialist to support utilization management processes with strong clinical knowledge and data-management skills. You will review requests, obtain missing information, and prepare cases for clinical review while handling nonclinical tasks to free up nursing staff.

Responsibilities include outreach to providers, documentation, and ensuring compliance with regulatory and quality requirements, with work-from-home options across multiple Western states.