Remote Inpatient Utilization Clinical Specialist

Cambia Health Solutions; United States; Remote; USD 59,000 - 79,000; Full time

Benefits offered by this job

Work from home options

Bonus target 5%

Job summary

Cambia Health Solutions is seeking an experienced Utilization Management Inpatient Clinical Specialist to support IP UM reviews from a home office across Washington, Oregon, Idaho, and Utah. The role partners with licensed clinicians to verify information, respond to requests, and ensure timely case handling.

Ideal candidates bring clinical expertise, strong communication skills, and proficiency with EMR and billing systems while thriving in a fast-paced environment.

Qualifications

• High school diploma or equivalent required.
• Clinical experience required; inpatient setting preferred.
• CMA or CNA preferred.
• Ability to work independently with a high-volume case load.

Responsibilities

• Research and review IP UM requests to ensure information is complete and take action to obtain details.
• Communicate effectively with internal and external stakeholders to complete role functions and notifications.
• Ensure timeliness of UM activities and compliance with regulatory requirements and corporate standards.
• Organize and maintain reference documents, policies, and procedures, fostering a professional environment.
• Perform research and problem-solving to ensure IP UM case accuracy and identify workflow improvements.
• Initiate referrals to adjacent teams as needed.

Skills

Clinical experience

Inpatient hospital experience

Communication skills

EMR documentation

Medical terminology (CPT/DX/HCPCS)

Independent work under high volume

Education

High school diploma or equivalent

CMA or CNA preferred

Tools

Microsoft Office

EMR systems

Billing and claims systems

Job description

Cambia Health Solutions is seeking an experienced Utilization Management Inpatient Clinical Specialist to support IP UM reviews from a home office across Washington, Oregon, Idaho, and Utah. The role partners with licensed clinicians to verify information, respond to requests, and ensure timely case handling.

Ideal candidates bring clinical expertise, strong communication skills, and proficiency with EMR and billing systems while thriving in a fast-paced environment.