Supervisor Clinical Appeals

Cambia Health Solutions; Boise (ID); Remote; USD 91,000 - 125,000; Full time

Job summary

A leading health solutions company seeks a Supervisor Clinical Appeals to oversee clinical appeal processes and lead a team of nursing professionals. This role involves ensuring compliance with medical policies and mentoring staff while working remotely within the region. The ideal candidate will have a strong background in nursing, leadership experience, and a commitment to improving member health journeys.

Benefits

Medical, dental and vision coverage

Annual employer contribution to a health savings account

Generous paid time off

Market-leading retirement plan

Up to 12 weeks of paid parental time off

Award-winning wellness programs

Qualifications

• 4 years of leadership experience required.
• 7 years of clinical experience or equivalent combination.
• RN License within ID, OR, UT, WA required.

Responsibilities

• Supervises team activities to achieve business objectives.
• Ensures clinical appeal decisions are accurate and consistent.
• Leads staff development through coaching and training.

Skills

Leadership

Communication

Problem Solving

Clinical Competency

Education

Bachelor’s degree in nursing or a related field

Tools

CPT coding

ICD-9 coding

HCPCS coding

MCG (Milliman Care Guidelines)

Job description

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Who We Are Looking For

Every day, Cambia’s dedicated team of clinical leaders are living our mission to make health care easier and lives better. As a member of the initial review team, our Supervisor Clinical Appeals supervises the team and acts as a resource for nursing professionals and support staff. This role oversees and coordinates team activities to achieve business objectives and ensures that clinical appeal decisions are accurate and consistent with medical policies, reimbursement policies, provider contracts, member benefits and supported by the medical record. The position may also assist in planning, coordinating, conducting and reporting on clinical appeals – all in service of making our members’ health journeys easier.

As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.

Do you thrive on mentoring and supporting nursing professionals? Are you skilled at analyzing medical policies and ensuring consistency in decision-making? Then this role may be the perfect fit.

Qualifications

What You Bring to Cambia:

• Bachelor’s degree in nursing or a related field
• 4 years of leadership experience
• 7 years of clinical experience or an equivalent combination of education and experience
• RN License within one of the four operating states (ID, OR, UT, WA)
• Certified Coder certified with the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) preferred
  
  

Skills And Attributes

• Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.
• Ability to communicate effectively, verbally and in writing to a variety of recipients/audiences.
• Ability to effectively develop and lead a team (including employees who may be in multiple locations or work remotely).
• Demonstrated experience in recognizing problems and effectively resolving complex issues.
• Familiarity with health insurance industry trends and technology.
• Demonstrated competency related to appeal procedures and clinical practices.
• Ability to apply best practices and designated standards.
• Knowledge of CPT, ICD-9 and HCPCS coding and MCG (Milliman Care Guidelines).
• Medicare regulations knowledge is preferred.
• Familiarity rules applied to appeals by accrediting bodies, state and federal governments, and employer groups.
  
  

What You Will Do At Cambia

• Manages team operations including work prioritization, goal setting, and performance monitoring while ensuring compliance with medical policies and guidelines
• Leads staff development through coaching, training, performance reviews, and regular communication via meetings and 1:1s
• Partners with physician advisors and other departments to resolve complex cases and remove operational barriers
• Develops and maintains process documentation, implements improvements, and ensures quality standards are met
• Maintains clinical competency while staying current on medical practices and industry trends
• Provides educational updates and serves as a technical resource for staff and other departments
• Manages special projects and provides backup support as needed while seeking continuous improvement opportunities
  
  

FTEs Supervised

8-15

The expected hiring range for a Supervisor Clinical Appeals is $91,800 - $124,200 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15%. The current full salary range for this role is $86,000 - $141,000.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, You Can

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
  
  

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

Benefits

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.
  
  

Learn More About Our Benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email [e-mail]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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