Remote Inpatient Utilization Specialist

Cambia Health Solutions; Spokane (WA); Remote; USD 3,292,000 - 5,359,000; Full time

Benefits offered by this job

Work from home options

Medical, dental and vision coverage

Paid time off and holidays

Job summary

Cambia Health Solutions is seeking an experienced UM IP Clinical Specialist to support inpatient utilization management through research, documentation, and collaboration with licensed health professionals. You will respond to inquiries, ensure complete information, and help maintain compliance with regulatory standards.

The role emphasizes timely case work, detailed documentation, and working with internal and external stakeholders to support efficient reviews and discharge planning when needed.

Qualifications

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

Responsibilities

• Research IP UM requests and take action to obtain necessary details; close cases accurately and efficiently.
• Communicate with internal and external stakeholders, including providers, to ensure compliance with regulatory and quality standards.
• Maintain timeliness and quality standards; meet production and confidentiality requirements in a fast-paced environment.
• Organize and maintain reference documents, policies and procedures; promote a professional work environment.
• Perform detailed research and problem-solve to ensure IP UM case accuracy and contribute to system improvements.
• Initiate referrals to adjacent teams as needed.
• Discuss discharge planning with providers and may assist with system testing.

Skills

Clinical experience

Communication skills

EMR navigation

Microsoft Office

Billing knowledge

Healthcare terminology

Education

High school diploma or equivalent

CMA or CNA preferred

Tools

Outlook

EMR systems

Job description

Cambia Health Solutions is seeking an experienced UM IP Clinical Specialist to support inpatient utilization management through research, documentation, and collaboration with licensed health professionals. You will respond to inquiries, ensure complete information, and help maintain compliance with regulatory standards.

The role emphasizes timely case work, detailed documentation, and working with internal and external stakeholders to support efficient reviews and discharge planning when needed.