Utilization Management – Inpatient Clinical Specialist

🔥 2 minutes ago

🥔 Idaho, Oregon, +2 more states – Remote

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

💵 $24 - $42 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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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

• Receive, research, and take action on documentation and requests related to Inpatient Utilization Management cases • Partner with licensed health professionals on appropriate actions and responses; role does not make clinical decisions • Research and review inpatient Utilization Management requests for completeness • Obtain necessary details and complete non-clinical tasks to close cases accurately and efficiently • Communicate with internal and external stakeholders, including providers and team members • Facilitate written notifications in compliance with regulatory and quality requirements • Manage UM activities to meet timeliness, production, quality, corporate, federal, state, BCBSA, and accreditation standards • Organize and maintain reference documents, policies, and procedures • Perform detailed research and problem-solving to ensure case accuracy and completeness • Identify opportunities to improve systems and workflows • Initiate referrals to adjacent teams as needed • Discuss discharge planning with providers as needed • Assist with systems testing when needed

🎯 Requirements

• High school diploma or equivalent • Clinical experience is required • At least 2 years of clinical experience preferred • CMA or CNA preferred • Clinical experience, preferably in an inpatient hospital setting • Strong oral and written communication skills • Computer skills including Microsoft Office, Outlook, and internet search • Experience with healthcare systems and documentation, EMRs, billing, and claims • Knowledge of medical terminology, anatomy, and coding, including CPT, DX, and HCPCs • Critical thinking, organization, data entry, and administrative skills • Ability to work independently with a high-volume caseload, prioritize tasks, meet deadlines, and work effectively in a team environment • Ability to adapt to changes in the healthcare insurance industry • Ability to maintain confidentiality • Wired internet connection; minimum 5Mb upload and 10Mb download speeds for work-from-home option • Personal mobile device required for MFA • Background check required

🏖️ Benefits

• Competitive salary • Market-leading 401(k) with a significant company match • Bonus opportunities • 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 varying by role and tenure • 10 company-paid holidays • Market-leading retirement plan with company match and potential discretionary contribution based on company performance, with no vesting period • Up to 12 weeks of paid parental time off after 12 months of continuous service • Award-winning wellness programs that reward participation • Employee Assistance Fund • Commute and parking benefits • Work from home options for most roles • Employee resource groups • Cambia-supported community outreach programs