Remote Clinical Specialist - Utilization Management

Cambia Health; Salem (OR); Remote; USD 37,000 - 59,000; Full time

Benefits offered by this job

Health benefits

401(k) with company match

Generous paid time off

Remote work options

Job summary

Cambia Health seeks a Clinical Specialist to support utilization management and regulatory requirements from a remote location. You will review requests, gather missing information, and prepare cases for clinical review, freeing RNs to focus on clinical work.

Strong data handling and communication skills are essential in this fast-paced environment. Role emphasizes independent work, teamwork, and mentoring teammates while leveraging AI tools to improve productivity and decision-making.

Qualifications

• High school diploma or equivalent with 2 years of clinical or hospital experience.
• LPN, CMA or CNA preferred.
• Strong communication and data management skills.

Responsibilities

• Research simple to moderately complex UM requests and related documentation.
• Review requests for completeness and prepare cases for clinical review.
• Complete nonclinical tasks, document information, and close cases accurately.
• Contact providers to request medical records and communicate determinations.
• Follow guidelines to meet timeliness, quality and regulatory requirements.

Skills

Clinical experience

Communication skills

Organizational skills

Data management

EMR familiarity

Independent working

Team collaboration

AI tools experience

Education

High school diploma

2 years clinical/hospital experience

LPN/CMA/CNA preferred

Tools

Microsoft Office

Outlook

EMR systems

Job description

Cambia Health seeks a Clinical Specialist to support utilization management and regulatory requirements from a remote location. You will review requests, gather missing information, and prepare cases for clinical review, freeing RNs to focus on clinical work.

Strong data handling and communication skills are essential in this fast-paced environment. Role emphasizes independent work, teamwork, and mentoring teammates while leveraging AI tools to improve productivity and decision-making.