Clinical Specialist – Nonclinical

Job not on LinkedIn

🔥 15 minutes ago

🥔 Idaho, Oregon, +2 more states – Remote

🥔 Idaho – Remote 🌲 Oregon – Remote ⛷️ Utah – Remote ☕ Washington – Remote

💵 $23 - $43 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Cambia Health Solutions

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

Cambia Health Solutions is a nonprofit, mission-driven healthcare company based in Portland, Oregon, that operates consumer-focused health care and health insurance businesses and invests in health innovation. It serves as the parent organization for the Regence family of health plans and runs initiatives and subsidiaries focused on improving care delivery, providing insurance products, and developing digital health tools and services.

📋 Description

• Research simple to moderately complex requests and documentation related to utilization management processes and regulatory requirements • Review requests for completeness, obtain missing information, and prepare cases for clinical review • Complete nonclinical case tasks, including documenting critical information, initiating referrals, and accurately closing cases • Conduct telephonic and written outreach to providers to request medical records and communicate case determinations, cancellations, and other information • Manage time and follow guidelines to meet timeliness, production, quality, accuracy, federal, state, BCBSA, and accreditation standards • Communicate across teams and maintain organized access to reference materials, policies, and procedures • Uphold a professional, ethical, member-focused work environment • Identify workflow and system improvement opportunities • Assist with systems testing, coordinate case information in external vendor systems, or discuss service planning with providers

🎯 Requirements

• High school diploma or equivalent and 2 years of clinical or hospital experience, or equivalent combination of education and experience • LPN, CMA or CNA preferred • Clinical experience, preferably in a hospital or health plan clinical services setting • Strong oral and written communication skills • Ability to work in a fast-paced environment while maintaining accuracy, confidentiality, and customer focus • Intermediate computer skills, including Microsoft Office, Outlook, and Internet search • Experience with health care systems and documentation, including EMR, billing, and claims • Knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCs) • Strong organization, data entry, and administrative skills • Ability to investigate and research complex UM case work issues and use critical thinking • Ability to work independently, prioritize work, meet deadlines, and achieve operational standards • Ability to work effectively in a team environment • Ability to perform UM Clinical Specialist duties and responsibilities • Ability to mentor coworkers and train new team members • Experience with AI tools and technologies highly desired • Personal mobile device required for MFA • Wired internet connection required; satellite or cellular internet is not accepted • Minimum internet speed of 5Mb upload and 10Mb download • Background check required

🏖️ Benefits

• 5% bonus target • Medical, dental and vision coverage for employees and eligible family members, including mental health benefits • Annual employer contribution to a health savings account • Generous paid time off • 10 company-paid holidays • 401(k) company match • Potential discretionary retirement contribution based on company performance, with no vesting period • Up to 12 weeks of paid parental time off after 12 months of continuous service • Wellness programs that reward participation • Employee Assistance Fund • Commute and parking benefits • Work from home option • Flexible work option requiring wired internet service with minimum upload/download speeds • Company-supported outreach programs • Employee resource groups • Competitive base pay