Remote Inpatient Utilization Specialist

Cambia Health Solutions; Bellevue (WA); Remote; USD 58,000 - 89,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Mental health benefits

401(k) retirement plan

Paid time off

Parental leave

Job summary

Cambia Health Solutions is seeking an UM IP Clinical Specialist to support inpatient utilization management. You will receive, research, and act on documentation and requests from diverse sources, collaborating with licensed clinicians to guide appropriate actions and timely reviews.

The role emphasizes strong clinical experience, careful communication, and adherence to regulatory standards within a fast-paced team environment.

Qualifications

• High school diploma or equivalent
• Clinical experience is required
• At least 2 years of clinical experience preferred
• CMA or CNA preferred

Responsibilities

• Research and review IP UM requests for completeness and take action to obtain details
• Communicate with internal and external stakeholders to accomplish role functions
• Manage time to ensure timeliness, production, and quality standards
• Organize and maintain reference documents, policies, and procedures
• Perform detailed research and problem-solve to ensure IP UM case accuracy
• Initiate referrals to adjacent teams as needed
• Discuss discharge planning with providers as needed

Skills

Clinical experience

Communication skills

Microsoft Office

EMRs documentation

Organization & data entry

Critical thinking

Education

High school diploma or equivalent

Tools

EMRs

Billing & claims systems

Microsoft Office & Outlook

Job description

Cambia Health Solutions is seeking an UM IP Clinical Specialist to support inpatient utilization management. You will receive, research, and act on documentation and requests from diverse sources, collaborating with licensed clinicians to guide appropriate actions and timely reviews.

The role emphasizes strong clinical experience, careful communication, and adherence to regulatory standards within a fast-paced team environment.