Remote Clinical Specialist - Utilization Management

Cambia Health Solutions; Heber (UT); Remote; USD 33,000 - 54,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

HSA contribution

PTO and holidays

401(k) with company match

Parental leave (up to 12 weeks)

Remote work option

Career growth opportunities

Job summary

Cambia Health Solutions is hiring a Clinical Specialist to work from home across Idaho, Oregon, Utah, and Washington. You will help manage utilization and ensure high-quality, timely case handling while supporting providers and members.

Ideal candidates have a high school diploma and 2 years of clinical or hospital experience, with strong organizational, data, and documentation skills to excel in a fast-paced environment.

Qualifications

• High school diploma or equivalent required.
• 2 years of clinical or hospital experience or equivalent mix of education and experience.

Responsibilities

• Conduct telephonic and written outreach to providers to obtain records and inform case determinations.
• Document critical information and initiate referrals for utilization management tasks.
• Meet regulatory and quality requirements while maintaining timeliness and accuracy.
• Mentor and train new team members; support workflow improvements and testing.

Skills

Organization skills

Data management

Microsoft Office

EMR systems

Medical terminology

CPT, DX, HCPCS coding

Communication skills

Attention to detail

Time management

Mentoring colleagues

Education

High school diploma or equivalent

Tools

EMR documentation software

Billing and claims software

Job description

Cambia Health Solutions is hiring a Clinical Specialist to work from home across Idaho, Oregon, Utah, and Washington. You will help manage utilization and ensure high-quality, timely case handling while supporting providers and members.

Ideal candidates have a high school diploma and 2 years of clinical or hospital experience, with strong organizational, data, and documentation skills to excel in a fast-paced environment.