Remote Utilization Management Clinical Specialist

Cambia Health Solutions; Eagle (ID); Remote; Full time

Benefits offered by this job

Health insurance

401(k) with match

Paid time off

Job summary

Cambia Health Solutions is seeking a Clinical Specialist to work from home within Idaho, Oregon, Utah, and Washington. Join our Clinical Operations team to support regulatory requirements, insource prior authorization volume, and help free RNs to focus on clinical work.

This role requires a high school diploma or equivalent and 2 years of clinical or hospital experience. You will use strong organizational and data-management skills, EMR familiarity, and the ability to mentor teammates while

Qualifications

• High school diploma or equivalent with 2 years clinical or hospital experience.
• Clinical experience preferred in hospital or health plan clinical services setting.
• Ability to work in a fast-paced environment with accuracy and confidentiality.
• Strong organization, data entry, and administrative skills.

Responsibilities

• Handle nonclinical tasks to support RNs and increase capacity.
• Conduct telephonic and written outreach to providers for medical records and case updates.
• Research simple to moderately complex utilization management (UM) requests.
• Ensure compliance with regulatory and accreditation requirements.

Skills

Organizational skills

Data management

Microsoft Office

EMR systems

Medical terminology

Anatomy knowledge

CPT coding

DX coding

HCPCS coding

Mentoring

Regulatory knowledge

Communication

Time management

Education

High school diploma or equivalent

Tools

EMR systems

Billing systems

Microsoft Office / Outlook

Job description

Cambia Health Solutions is seeking a Clinical Specialist to work from home within Idaho, Oregon, Utah, and Washington. Join our Clinical Operations team to support regulatory requirements, insource prior authorization volume, and help free RNs to focus on clinical work.

This role requires a high school diploma or equivalent and 2 years of clinical or hospital experience. You will use strong organizational and data-management skills, EMR familiarity, and the ability to mentor teammates while