Supervisor Clinical Appeals

Cambia Health Solutions; Renton (WA); Remote; USD 91,000 - 125,000; Full time

Job summary

Cambia Health Solutions is seeking a Supervisor Clinical Appeals to lead a team focused on ensuring accurate clinical appeal decisions. This role requires strong leadership, clinical expertise, and the ability to mentor nursing professionals while overseeing team operations and compliance.

Benefits

Medical, dental, vision coverage

Health savings account contributions

Paid time off and holidays

Retirement plan with company match

Paid parental leave

Wellness programs

Commute and parking benefits

Qualifications

• 4 years of leadership experience required.
• 7 years of clinical experience or equivalent combination of education and experience.

Responsibilities

• Manage team operations, ensuring compliance with policies.
• Lead staff development and performance reviews.
• Collaborate with physicians to resolve complex cases.

Skills

Effective communication

Problem recognition and resolution

Knowledge of health insurance industry trends

Understanding of appeal procedures

Ability to set priorities

Education

Bachelor’s degree in nursing

RN License

Job description

Join to apply for the Supervisor Clinical Appeals role at Cambia Health Solutions

Work from home within Oregon, Washington, Idaho or Utah

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For

Every day, Cambia’s dedicated team of clinical leaders live our mission to make health care easier and lives better. As a member of the initial review team, the 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 clinical appeal decisions are accurate and aligned with medical policies, reimbursement policies, provider contracts, member benefits, and supported by medical records. The position may also assist in planning, coordinating, conducting, and reporting on clinical appeals to make members’ health journeys easier.

As a people leader, you are willing to learn and grow, supporting your team and the lives that depend on us.

Do you thrive on mentoring nursing professionals? Are you skilled at analyzing medical policies and ensuring decision-making consistency? This role may be a good 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 in ID, OR, UT, or WA
• Certified Coder (preferred)

Skills And Attributes

• Ability to set priorities and oversee team outputs and timelines
• Effective communication skills
• Experience in leading remote or multi-location teams
• Problem recognition and resolution skills
• Knowledge of health insurance industry trends and technology
• Understanding of appeal procedures and clinical practices
• Knowledge of CPT, ICD-9, HCPCS, and MCG guidelines
• Medicare regulations knowledge (preferred)
• Familiarity with appeal rules by accrediting bodies and government agencies

What You Will Do At Cambia

• Manage team operations, ensuring compliance with policies
• Lead staff development and performance reviews
• Collaborate with physicians and departments to resolve complex cases
• Develop and maintain process documentation
• Stay current on medical practices and industry trends
• Provide educational updates and serve as a technical resource
• Manage special projects and seek continuous improvements

Additional Details

Expected salary range: $91,800 - $124,200, with a bonus target of 15%. Full salary range: $86,000 - $141,000.

About Cambia

We are a purpose-driven, innovative culture with a 100+ year history. Our team is committed to sustainable, person-focused health care, emphasizing compassion and community involvement.

Why Join Us?

• Work with diverse teams on innovative health care solutions
• Earn a competitive salary with comprehensive benefits
• Grow your career with a supportive company
• Participate in community outreach programs
• Connect through employee resource groups

Benefits

• Medical, dental, vision, and mental health coverage
• Health savings account contributions
• Paid time off and holidays
• Retirement plan with company match
• Paid parental leave
• Wellness programs and assistance funds
• Commute and parking benefits

Work from home options available, requiring reliable internet with specified speeds.

We are an Equal Opportunity employer. Background checks are required. For accommodations, contact [e-mail].