Remote Clinical Specialist – UM & Provider Support

Cambia Health; Boise (ID); Remote; USD 37,000 - 59,000; Full time

Benefits offered by this job

Health insurance

401(k) with company match

Paid time off

Parental leave

Wellness programs

Employee assistance fund

Commuting benefits

Job summary

Cambia Health is seeking a Clinical Specialist who applies clinical knowledge to utilization management and regulatory requirements. You will review requests, gather missing information, and prepare cases for clinical review while maintaining high accuracy and confidentiality.

The role emphasizes strong communication, data management, and the ability to work with providers to obtain records, with flexible work-from-home options in Idaho and nearby states.

Qualifications

• High school diploma or equivalent with 2 years clinical or hospital experience.
• LPN, CMA or CNA preferred.
• Strong communication and documentation skills.
• Experience with EMR and healthcare systems.

Responsibilities

• Research simple to moderately complex UM requests using clinical knowledge and regulatory requirements.
• Review requests for completeness and prepare cases for clinical review.
• Complete nonclinical case tasks and document critical information accurately.
• Contact providers by phone and written outreach to obtain records and communicate determinations.
• Meet departmental standards for timeliness, production, quality, and accuracy.
• Collaborate across teams and maintain organized reference materials and procedures.
• Identify workflow and system improvements and assist with testing or vendor coordination.

Skills

Clinical experience

Communication skills

Fast-paced work

Computer skills

Medical terminology

Organizational skills

Investigation & research

Mentoring

AI tools experience

Education

High school diploma or equivalent

LPN/CMA/CNA preferred

Tools

Microsoft Office

Outlook

EMR systems

Billing and claims

Job description

Cambia Health is seeking a Clinical Specialist who applies clinical knowledge to utilization management and regulatory requirements. You will review requests, gather missing information, and prepare cases for clinical review while maintaining high accuracy and confidentiality.

The role emphasizes strong communication, data management, and the ability to work with providers to obtain records, with flexible work-from-home options in Idaho and nearby states.