Remote Clinical Specialist – Utilization & Case Support

Cambia Health Solutions; Oregon; Remote; USD 37,000 - 60,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

401(k) with company match

Work from home flexibility

MFA security requirement

Equal Opportunity employer

Job summary

Cambia Health Solutions is seeking a Clinical Specialist who will support utilization management processes and regulatory requirements from a remote/home-based setting across Idaho, Oregon, Utah, and Washington. This role frees RNs to focus on clinical work by handling nonclinical UM tasks and coordinating with clinicians and providers.

Ideal candidates have a background in clinical settings, strong written and verbal communication, and comfort with health system documentation including EMR,

Qualifications

• High school diploma or equivalent with 2 years clinical or hospital experience; LPN/CMA/CNA preferred.

Responsibilities

• Research simple to moderately complex UM requests using clinical knowledge and critical thinking.
• Review requests for completeness and prepare cases for clinical review.
• Complete nonclinical tasks, document important information, and close cases accurately.
• Contact providers by phone or email to request records and communicate determinations, complying with requirements.
• Meet departmental timeliness, production, quality, and accuracy standards and regulatory requirements.
• Collaborate within teams and maintain organized reference materials and processes.
• Identify workflow or system opportunities and assist with testing or planning with providers.

Skills

Clinical experience

Communication skills

Organizational skills

Independent worker

Team player

Data management

AI tools familiarity

Microsoft Office

Education

High school diploma or equivalent; 2 years clinical/hospital experience

Tools

EMR systems

Billing and claims software

Microsoft Office

Outlook

Internet research

Job description

Cambia Health Solutions is seeking a Clinical Specialist who will support utilization management processes and regulatory requirements from a remote/home-based setting across Idaho, Oregon, Utah, and Washington. This role frees RNs to focus on clinical work by handling nonclinical UM tasks and coordinating with clinicians and providers.

Ideal candidates have a background in clinical settings, strong written and verbal communication, and comfort with health system documentation including EMR,