Remote Inpatient Utilization Specialist

Cambia Health Solutions; Washington; Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

401(k) with company match

Paid time off

Holidays

Wellness programs

Employee Assistance Fund

Commuting benefits

Job summary

Cambia Health Solutions seeks an UM IP Clinical Specialist to review inpatient utilization requests, research information, and coordinate with clinicians to support efficient reviews. The role emphasizes accuracy, timeliness, and adherence to regulatory standards.

Work-from-home options are available in many regions with emphasis on member-focused service and collaboration with internal and external stakeholders. Strong clinical background and EMR experience are preferred.

Qualifications

• Clinical experience is required.
• Experience in inpatient setting preferred.
• Knowledge of medical terminology and coding.

Responsibilities

• Review IP UM requests and ensure completeness of information.
• Communicate with providers and team members to comply with regulations.
• Maintain references and perform research to ensure accuracy and quality.

Skills

Clinical experience

Communication skills

MS Office / Outlook

EMR documentation

Medical terminology & coding

Independent with high-volume caseload

Team collaboration

Education

High school diploma or equivalent

CMA or CNA certification preferred

Tools

EMR systems

Job description

Cambia Health Solutions seeks an UM IP Clinical Specialist to review inpatient utilization requests, research information, and coordinate with clinicians to support efficient reviews. The role emphasizes accuracy, timeliness, and adherence to regulatory standards.

Work-from-home options are available in many regions with emphasis on member-focused service and collaboration with internal and external stakeholders. Strong clinical background and EMR experience are preferred.