Remote Inpatient Utilization Specialist (UM IP)

Cambia Health Solutions; Medford (OR); Remote; USD 33,000 - 54,000; Full time

Benefits offered by this job

Health benefits

401(k) with company match

Job summary

Cambia Health Solutions is seeking an UM IP Clinical Specialist to review inpatient utilization requests, partner with licensed clinicians, and support efficient clinical reviews while not making clinical decisions. The role emphasizes documentation, collaboration with providers, and adherence to regulatory standards.

The position offers work-from-home options for many roles and requires strong clinical experience, with a focus on accuracy, timeliness, and quality in a fast-paced healthcare

Qualifications

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

Responsibilities

• Utilize clinical knowledge and critical thinking to research and review IP UM requests, ensuring information completeness and closing cases accurately.
• Communicate with providers and team members to accomplish role functions and issue notifications in compliance with regulatory and quality entities.
• Manage time effectively to ensure timely UM activities and compliance with regulatory and quality standards.
• Organize and maintain reference documents, policies, and procedures; foster a professional, ethical work environment with stakeholders.
• Conduct detailed research and problem-solve to ensure IP UM case accuracy and contribute to system/workflow improvements.
• Initiate referrals to adjacent teams as needed.
• Discuss discharge planning with providers and may assist with systems testing, adhering to department performance criteria.

Skills

Clinical experience

EMR familiarity

Communication skills

Independent work

Tools

Microsoft Office

EMRs

Job description

Cambia Health Solutions is seeking an UM IP Clinical Specialist to review inpatient utilization requests, partner with licensed clinicians, and support efficient clinical reviews while not making clinical decisions. The role emphasizes documentation, collaboration with providers, and adherence to regulatory standards.

The position offers work-from-home options for many roles and requires strong clinical experience, with a focus on accuracy, timeliness, and quality in a fast-paced healthcare