Remote Clinical Specialist - Utilization & Admin Support

Cambia Health Solutions, Inc.; Washington (UT); Remote; USD 32,000 - 59,000; Full time

Benefits offered by this job

Generous benefits

401(k) with company match

Paid time off

Holidays

Job summary

Cambia Health Solutions, Inc. is seeking a Clinical Specialist to support utilization management by handling nonclinical tasks and coordinating case information. You’ll review requests, gather records, and communicate determinations while upholding regulatory standards.

The role emphasizes organization, accuracy, and teamwork within a fast-paced environment, with remote work options available across several states. Training and mentoring may be provided.

Qualifications

• High school diploma or equivalent and 2 years of clinical or hospital experience.
• LPN, CMA or CNA preferred as additional qualification.
• Strong communication, organization, accuracy, and confidentiality.

Responsibilities

• Research simple to moderately complex requests related to UM processes.
• Review requests for completeness and prepare cases for clinical review.
• Complete nonclinical tasks: document information, initiate referrals, close cases.
• Contact providers by phone or written outreach to obtain records and inform decisions.
• Work with teams to meet timeliness, quality, and regulatory standards.

Skills

Clinical experience

Communication skills

MS Office

EMR/Billing/claims

Medical terminology

Attention to detail

Teamwork

Independent work

Mentoring/training

AI tools experience

Education

High school diploma or equivalent

LPN/CMA/CNA preferred

Tools

MS Office

Outlook

EMR systems

Billing systems

Job description

Cambia Health Solutions, Inc. is seeking a Clinical Specialist to support utilization management by handling nonclinical tasks and coordinating case information. You’ll review requests, gather records, and communicate determinations while upholding regulatory standards.

The role emphasizes organization, accuracy, and teamwork within a fast-paced environment, with remote work options available across several states. Training and mentoring may be provided.