Clinical Specialist; nonclinical

## Clinical Specialist (nonclinical)
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Idaho:
Oregon:
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Utah:
Full time:
Posted Today:
R-7004

Clinical Specialist Work from home within Idaho, Oregon, Utah, and Washington. Preference will be given to current employees and candidates who reside in 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 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? Do you work effectively in a team environment? Then this role may be the perfect fit.  
** What You Bring to Cambia:*
* *
* Qualifications:

*
* · 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. LPN, CMA or CNA preferred.  
** Skills and Attributes:*
* · Clinical experience, preferably in a hospital setting or a health plan clinical services setting.
· Strong and effective communication skills, both oral and written.
· 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 investigate and research complex issues and inquiries related to UM case work, use critical thinking skills and work with clinical staff to resolve them.
· Ability to work independently, to prioritize work, meet deadlines and achieve operational standards.
· Ability to work effectively in a team environment.
· 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  
· Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.  
** What You Will Do at Cambia:*
* · Uses clinical knowledge and critical thinking to research simple to moderately complex requests and documentation related to utilization management (UM) processes and regulatory requirements.
· Reviews requests for completeness, obtains any missing information, and prepares cases for clinical review.
· 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…