Remote Inpatient Utilization Clinical Specialist

Cambia Health Solutions; Burlington (WA); À distance; USD 39 000 - 52 000; Plein temps

Avantages offerts par ce poste

Work from home options

Competitive benefits

401(k) with company match

Paid time off

Résumé du poste

Cambia Health Solutions is seeking an UM IP Clinical Specialist to review inpatient utilization requests, research documentation, and respond to inquiries. You will partner with licensed clinicians to support clinical reviews and ensure accurate, timely action in a fast-paced environment.

You will collaborate with providers and internal teams, maintain documentation, and adhere to regulatory and quality standards while focusing on member outcomes and service excellence.

Qualifications

• High school diploma or equivalent is required.
• Clinical experience is required; CMA/CNA preferred but not required.
• Experience with EMRs, billing and claims is preferred.
• Strong communication skills and ability to work independently and in a team.

Responsabilités

• Research and review IP UM requests; obtain necessary details.
• Communicate with internal and external stakeholders clearly.
• Ensure timeliness and compliance with regulatory and quality standards.
• Maintain reference documents and contribute to process improvements.
• Perform research and problem solving to ensure case accuracy.
• Initiate referrals to adjacent teams as needed.
• Discuss discharge planning with providers when required.

Connaissances

Clinical experience

Communication skills

Microsoft Office

Outlook

EMR systems

Billing and claims

Medical terminology

Coding knowledge (CPT, DX, HCPCS)

Critical thinking

Organization and data entry

Formation

High school diploma or equivalent

CMA or CNA preferred

Outils

EMR systems

Microsoft Office

Outlook

Description du poste

Cambia Health Solutions is seeking an UM IP Clinical Specialist to review inpatient utilization requests, research documentation, and respond to inquiries. You will partner with licensed clinicians to support clinical reviews and ensure accurate, timely action in a fast-paced environment.

You will collaborate with providers and internal teams, maintain documentation, and adhere to regulatory and quality standards while focusing on member outcomes and service excellence.