[Hiring] Utilization Management Inpatient Clinical Specialist @Cambia Health Solutions

Role Description

As a member of the Clinical Services team, the Utilization Management Inpatient (UM IP) Clinical Specialist receives, researches, and takes action related to documentation and requests from various sources related to Inpatient Utilization Management cases. The UM IP Clinical Specialist partners with licensed health professionals on appropriate actions and responses to support efficient and effective clinical reviews.

• Utilize clinical knowledge and critical thinking to research and review IP UM requests.
• Communicate effectively with internal and external stakeholders, including providers and team members.
• Exhibit excellent time management skills to ensure timeliness of UM activities.
• Organize and maintain reference documents, policies, and procedures.
• Perform detailed research and problem-solve using sound decision-making skills.
• Initiate referrals to adjacent teams as needed.
• Discuss discharge planning with providers as needed.

Qualifications

• High school diploma or equivalent.
• Clinical experience is required.
• At least 2 years of clinical experience preferred.
• CMA or CNA preferred.
• Strong communication skills, both oral and written.
• Computer skills, including Microsoft Office, Outlook, and internet search.
• Knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCs).

Requirements

• Ability to work independently with a high volume case load.
• Prioritize tasks, meet deadlines, and achieve operational standards.
• Maintain confidentiality and focus on meeting customer needs.
• Adapt to changes in the healthcare insurance industry.
• Utilize strong organization, data entry, and administrative skills.

Benefits

• 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.
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service).
• Award-winning wellness programs that reward participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.