Supervisor Clinical Appeals

Supervisor Clinical Appeals

Work from home within Oregon, Washington, 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 leaders are living our mission to make health care easier and lives better. As a member of the initial review team, our Supervisor Clinical Appeals supervises the team and acts as a resource for nursing professionals and support staff. This role oversees and coordinates team activities to achieve business objectives and ensures that clinical appeal decisions are accurate and consistent with medical policies, reimbursement policies, provider contracts, member benefits and supported by the medical record. The position may also assist in planning, coordinating, conducting and reporting on clinical appeals – all in service of making our members’ health journeys easier.

As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.

Do you thrive on mentoring and supporting nursing professionals? Are you skilled at analyzing medical policies and ensuring consistency in decision-making? Then this role may be the perfect fit.

What You Bring to Cambia: 

Qualifications:  

• Bachelor’s degree in nursing or a related field

• 4 years of leadership experience

• 7 years of clinical experience or an equivalent combination of education and experience

• RN License within one of the four operating states (ID, OR, UT, WA)

• Certified Coder certified with the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) preferred

Skills and Attributes: 

• Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.

• Ability to communicate effectively, verbally and in writing to a variety of recipients/audiences.

• Ability to effectively develop and lead a team (including employees who may be in multiple locations or work remotely).

• Demonstrated experience in recognizing problems and effectively resolving complex issues.  

• Familiarity with health insurance industry trends and technology.

• Demonstrated competency related to appeal procedures and clinical practices.

• Ability to apply best practices and designated standards.

• Knowledge of CPT, ICD-9 and HCPCS coding and MCG (Milliman Care Guidelines).   

• Medicare regulations knowledge is preferred.

• Familiarity rules applied to appeals by accrediting bodies, state and federal governments, and employer groups.

What You Will Do at Cambia:  

• Manages team operations including work prioritization, goal setting, and performance monitoring while ensuring compliance with medical policies and guidelines

• Leads staff development through coaching, training, performance reviews, and regular communication via meetings and 1:1s

• Partners with physician advisors and other departments to resolve complex cases and remove operational barriers

• Develops and maintains process documentation, implements improvements, and ensures quality standards are met

• Maintains clinical competency while staying current on medical practices and industry trends

• Provides educational updates and serves as a technical resource for staff and other departments

• Manages special projects and provides backup support as needed while seeking continuous improvement opportunities

FTEs Supervised

8-15

#LI-Remote

The expected hiring range for a Supervisor Clinical Appeals is $91,800 - $124,200 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15%.  The current full salary range for this role is $86,000 - $141,000