Senior Medical Policy Implementation Lead (Hybrid)

Cambia Health Solutions, Inc.; Lewiston (ID); Hybrid; USD 80,000 - 130,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

401(k) with company match

10 company-paid holidays

Paid parental leave (up to 12 weeks)

Work from home options

Job summary

Cambia Health Solutions, Inc. seeks a Medical Policy Implementation Analyst Senior for a hybrid role (3 days in office) with offices in Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, Lewiston, Little Rock and Springdale.

You will translate clinical policies into clear guidance, support policy implementation, and collaborate withMedical Directors and teams. Preferred candidates hold a health science degree, RN licensure, and CPC certification within 6 months.

Qualifications

• Bachelor’s degree in health science or related field with 5 years in medical policy work.
• RN license required; CPC must be attained within 6 months if not current.

Responsibilities

• Drafts, interprets and applies medical policies and presents criteria to Medical Directors for approval.
• Tracks utilization patterns and appeals to inform policy changes.
• Applies CPT, HCPCS and ICD coding to policy criteria with impact analysis.
• Publishes and maintains a web library of clinical criteria accessible to users.
• Manages projects with deadlines and documentation for accreditation standards.
• Communicates policy questions and decisions with internal and external stakeholders.

Skills

Anatomy & physiology

CPT/ICD coding

CMS guidelines

Policy interpretation

Project management

AI tools

Education

Bachelor’s degree in health science or related field

RN license

Tools

Microsoft Office

Outlook

Job description

Cambia Health Solutions, Inc. seeks a Medical Policy Implementation Analyst Senior for a hybrid role (3 days in office) with offices in Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, Lewiston, Little Rock and Springdale.

You will translate clinical policies into clear guidance, support policy implementation, and collaborate withMedical Directors and teams. Preferred candidates hold a health science degree, RN licensure, and CPC certification within 6 months.