Clinical Specialist (nonclinical)

Clinical Specialist Work from home within Idaho, Oregon, Utah, and Washington. Join our Cause to create a person-focused and economically sustainable health care system. Every day, Cambia's dedicated team of Clinical Specialist is living our mission to make health care easier and lives better. As a member of the Clinical Operations team, our Clinical Specialists help us meet regulatory requirements as we insource prior authorization volume, support key initiatives, and ensure strong staffing coverage. By handling nonclinical tasks, they free up RNs to focus on clinical work and increase overall capacity - all in service of making our members' health journeys easier. Do you have strong organization and data management skills? Clinical Specialist would have a high school diploma or equivalent and 2 years of clinical or hospital experience, or an equivalent combination of education and experience. Clinical experience, preferably in a hospital setting or a health plan clinical services setting. Ability to work in a fast-paced environment while maintaining accuracy of work, confidentiality, and focus on meeting customer needs. Intermediate computer skills (e.g. Microsoft Office, Outlook, Internet search) and experience with health care systems and documentation (EMR, billing and claims). Demonstrated knowledge of medical terminology, anatomy and coding (CPT, DX, HCPCs). Strong organization, data entry, and administrative skills. Ability to perform job duties and responsibilities for an UM Clinical Specialist. Ability to mentor and support co-workers and provide training to new team members Uses clinical knowledge and critical thinking to research simple to moderately complex requests and documentation related to utilization management (UM) processes and regulatory requirements. Completes nonclinical case tasks, including documenting critical information, initiating referrals, and closing cases accurately. Conducts telephonic and written outreach to providers to request medical records and communicate case determinations, cancellations, and other information in compliance with regulatory and quality requirements. Manages time effectively and follows established guidelines to meet departmental standards for timeliness, production, quality, and accuracy, as well as federal, state, BCBSA, and accreditation requirements. Communicates effectively within and across teams, maintains organized access to reference materials, policies, and procedures, and upholds a professional, ethical, member-focused work environment. Supports continuous improvement by identifying workflow and system opportunities, and may assist with systems testing, coordinate case information in external vendor systems, or discuss service planning with providers. The expected hiring range depends on skills, experience, education, and training; and performance history. National pay structure - applies to Washington, Oregon, and to the Boise, Lewiston, and Salt Lake City metro areas: The full hourly range is $26.50 - $43.20 per hour and the bonus target is 5%. Regional pay structure - applies to Idaho, and Utah locations outside the metro areas listed above: The full hourly range is $23.90 - $38.90 per hour and the bonus target is 5%. 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. Work alongside diverse teams building cutting-edge solutions to transform health care. Grow your career with a company committed to helping you succeed. Give back to your community by participating in Cambia-supported outreach programs. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more. In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. 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). 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. As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. 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. If you need accommodation for any part of the application process because of a medical condition or disability, please email about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. #J-18808-Ljbffr