Remote Clinical Specialist, Utilization Management

Cambia Health Solutions; Utah; À distance; USD 37 000 - 60 000; Plein temps

Avantages offerts par ce poste

Medical, dental and vision coverage

Health Savings Account (HSA)

Paid time off and holidays

401(k) with company match

Parental leave

Résumé du poste

Cambia Health Solutions is hiring a Clinical Specialist to work from home across Idaho, Oregon, Utah, and Washington. The role supports utilization management by handling nonclinical tasks, coordinating with providers, and documenting cases while freeing RNs for direct patient care.

Applicants should have a high school diploma and at least 2 years of clinical or hospital experience, with strong organizational and data management skills. Prior hospital or health plan experience is preferred.

Qualifications

• High school diploma or equivalent.
• 2 years of clinical or hospital experience.
• Clinical experience preferred in hospital or health plan setting.
• Experience with EMR, billing and claims.

Responsabilités

• Handle nonclinical tasks to free up RNs for clinical work.
• Support regulatory requirements and insource prior authorization volume.
• Conduct telephonic and written outreach to providers to request medical records.
• Document critical information and initiate referrals and case closures.
• Meet timeliness, production, quality, and accuracy standards.

Connaissances

Organizational skills

Data management

Mentoring

Research & critical thinking

Provider communication

Formation

High school diploma

Outils

Microsoft Office

EMR systems

Outlook

Description du poste

Cambia Health Solutions is hiring a Clinical Specialist to work from home across Idaho, Oregon, Utah, and Washington. The role supports utilization management by handling nonclinical tasks, coordinating with providers, and documenting cases while freeing RNs for direct patient care.

Applicants should have a high school diploma and at least 2 years of clinical or hospital experience, with strong organizational and data management skills. Prior hospital or health plan experience is preferred.