Remote RN Appeals Clinician I

Cambia Health Solutions; Eagle (ID); Remote; USD 43,000 - 79,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Health savings account

Paid time off

Job summary

Cambia Health Solutions is seeking an Appeals Clinician I to work from home within Oregon, Washington, Idaho or Utah. You will complete the clinical component of all appeal types to resolve member and/or provider appeals, leveraging nursing expertise and policy knowledge.

As an RN with a Bachelor’s in Nursing and at least 3 years in clinical settings, you will assess records, interpret benefits, and communicate complex clinical topics with clinical and non-clinical staff. Remote option supported.

Qualifications

• Bachelor's Degree in Nursing and 3 years of clinical experience or equivalent.
• Active licensure in a U.S. state that allows independent clinical assessment.
• RN license in OR/WA/ID/UT where applicable.

Responsibilities

• Complete the clinical component of all appeal types to resolve member or provider appeals.
• Apply nursing expertise to ensure medical policy compliance and appropriate determinations.
• Consult with physician advisers to support clinically appropriate decisions.

Skills

Claim review

Clinical assessment

Policy compliance

RN licensed

CPT/ICD coding

Documentation

MS Office

MCG guidelines

Education

Bachelor's Degree in Nursing

RN license

Tools

Microsoft Word

Excel

PowerPoint

Access

Job description

Cambia Health Solutions is seeking an Appeals Clinician I to work from home within Oregon, Washington, Idaho or Utah. You will complete the clinical component of all appeal types to resolve member and/or provider appeals, leveraging nursing expertise and policy knowledge.

As an RN with a Bachelor’s in Nursing and at least 3 years in clinical settings, you will assess records, interpret benefits, and communicate complex clinical topics with clinical and non-clinical staff. Remote option supported.