Remote Clinical Specialist - Utilization Management

Cambia Health; Olympia (WA); 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

Job summary

Cambia Health seeks an experienced Clinical Specialist to support utilization management, case processing, and provider outreach. The role emphasizes accurate documentation, timely case handling, and collaboration with clinical staff to resolve UM inquiries in a fast-paced health plan environment.

The role supports work-from-home options across defined states, with a focus on Idaho, Utah and surrounding regions, and includes a competitive benefits package and opportunities for professional

Qualifications

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

Responsibilities

• Research simple to moderately complex UM requests and documentation.
• Review requests for completeness and prepare cases for clinical review.
• Complete nonclinical case tasks, document information, initiate referrals, close cases accurately.
• Outreach to providers by phone and email to request records and relay determinations per regulations.
• Manage time to meet timeliness, production, quality, and regulatory standards.
• Communicate across teams and maintain organized reference materials.
• Identify workflow opportunities and assist with systems testing or service planning.
• Coordinate with external vendors as needed.

Skills

Clinical experience

Strong communication

Teamwork

Data management

EMR systems

Medical terminology

Organizational skills

Independence

Mentoring

AI tools knowledge

Education

High school diploma or equivalent

Tools

Microsoft Office

Outlook

EMR interfaces

Job description

Cambia Health seeks an experienced Clinical Specialist to support utilization management, case processing, and provider outreach. The role emphasizes accurate documentation, timely case handling, and collaboration with clinical staff to resolve UM inquiries in a fast-paced health plan environment.

The role supports work-from-home options across defined states, with a focus on Idaho, Utah and surrounding regions, and includes a competitive benefits package and opportunities for professional