Remote RN Appeals Clinician I — Patient Advocate

Cambia Health; Spokane (WA); Remote; USD 44,000 - 79,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Health savings account

Paid time off

401(k) plan with company match

Parental leave

Job summary

Cambia Health is seeking an Appeals Clinician I to support members and providers through clinical appeals. This remote role can be done from Oregon, Washington, Idaho or Utah, with preference for Idaho and Utah residents.

You will apply nursing expertise and medical policy to ensure accurate decisions, collaborate with physician advisers, and educate non-clinical staff. A current RN license and strong documentation are required.

Qualifications

• Bachelor's Degree in Nursing required.
• Active RN license in OR/WA/ID/UT or eligible.
• 3+ years clinical experience in health insurance, claims review or case management.

Responsibilities

• Conduct clinical appeal reviews per medical policy and guidelines.
• Consult with physicians to ensure appropriate determinations.
• Educate non-clinical staff on clinical cases and decisions.

Skills

Claim review

Nursing clinical skills

Medical policy knowledge

Medical coding (CPT/ICD-9/HCPCS)

Reading medical records

Communication skills

AI tools familiarity

Microsoft Office

Education

Bachelor's Degree in Nursing

RN license

Tools

Microsoft Word

Excel

PowerPoint

Access

Job description

Cambia Health is seeking an Appeals Clinician I to support members and providers through clinical appeals. This remote role can be done from Oregon, Washington, Idaho or Utah, with preference for Idaho and Utah residents.

You will apply nursing expertise and medical policy to ensure accurate decisions, collaborate with physician advisers, and educate non-clinical staff. A current RN license and strong documentation are required.