Payment Integrity Nurse I Cambia Health Solutions IncPayment Integrity Nurse IPortland, ORRemote$73,230.90–$99,077.10 / yearAs a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Excellent computer skills and proficiency working software programs (i.e. Microsoft Word, Excel, and PowerPoint); learn new processes and systems quickly.
Payment Integrity Nurse I Cambia Health Solutions IncPayment Integrity Nurse IBellevue, WARemote$73,230.90–$99,077.10 / yearAs a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Excellent computer skills and proficiency working software programs (i.e. Microsoft Word, Excel, and PowerPoint); learn new processes and systems quickly.
Payment Integrity Nurse I Cambia Health Solutions IncPayment Integrity Nurse IBend, ORRemote$73,230.90–$99,077.10 / yearAs a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Excellent computer skills and proficiency working software programs (i.e. Microsoft Word, Excel, and PowerPoint); learn new processes and systems quickly.
Payment Integrity Nurse I Cambia Health Solutions IncPayment Integrity Nurse ILewiston, IDRemote$73,230.90–$99,077.10 / yearAs a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Excellent computer skills and proficiency working software programs (i.e. Microsoft Word, Excel, and PowerPoint); learn new processes and systems quickly.
Payment Integrity Nurse I Cambia Health Solutions IncPayment Integrity Nurse IRenton, WARemote$73,230.90–$99,077.10 / yearAs a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Excellent computer skills and proficiency working software programs (i.e. Microsoft Word, Excel, and PowerPoint); learn new processes and systems quickly.
Payment Integrity Nurse I Cambia Health Solutions IncPayment Integrity Nurse IVancouver, WARemote$73,230.90–$99,077.10 / yearAs a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Excellent computer skills and proficiency working software programs (i.e. Microsoft Word, Excel, and PowerPoint); learn new processes and systems quickly.
Manager Clinical Pharmacy Quality and Affordability Programs Cambia Health Solutions IncManager Clinical Pharmacy Quality and Affordability ProgramsFargo, ND$146,149.85–$197,732.15 / yearDemonstrated knowledge of: Medicare/CMS regulations and applicability in administering the Medicare Product; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; Health care coding and payment systems (such as ICD-10, CPT, HCPCS, NDC); Compliance related activities, legislative and regulatory activities; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA. Collaborates with the Pharmacy Directors, VPs, and other leadership in coordinating corporate-wide activities related to the appropriate use of medications, improved quality related to medication therapy, promotion of cost-effective prescribing, and reduction in short-term and long-term overall costs to internal and external clients.
Manager Clinical Pharmacy Quality and Affordability Programs Cambia Health Solutions IncManager Clinical Pharmacy Quality and Affordability ProgramsMedford, OR$146,149.85–$197,732.15 / yearDemonstrated knowledge of: Medicare/CMS regulations and applicability in administering the Medicare Product; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; Health care coding and payment systems (such as ICD-10, CPT, HCPCS, NDC); Compliance related activities, legislative and regulatory activities; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA. Collaborates with the Pharmacy Directors, VPs, and other leadership in coordinating corporate-wide activities related to the appropriate use of medications, improved quality related to medication therapy, promotion of cost-effective prescribing, and reduction in short-term and long-term overall costs to internal and external clients.
Manager Clinical Pharmacy Quality and Affordability Programs Cambia Health Solutions IncManager Clinical Pharmacy Quality and Affordability ProgramsRenton, WA$146,149.85–$197,732.15 / yearDemonstrated knowledge of: Medicare/CMS regulations and applicability in administering the Medicare Product; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; Health care coding and payment systems (such as ICD-10, CPT, HCPCS, NDC); Compliance related activities, legislative and regulatory activities; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA. Collaborates with the Pharmacy Directors, VPs, and other leadership in coordinating corporate-wide activities related to the appropriate use of medications, improved quality related to medication therapy, promotion of cost-effective prescribing, and reduction in short-term and long-term overall costs to internal and external clients.
Senior Data Platform Engineer / SDE Cambia Health Solutions IncSenior Data Platform Engineer / SDERenton, WA$101,000–$134,000 / yearWhat You Bring to Cambia: Preferred Key Experience: Experienced technical lead with a strong background in building and optimizing data pipelines, excellent SQL skills, and hands‑on expertise with Snowflake, dbt, and modern ELT practices. Skills and Attributes (Not limited to): Deep expertise with Snowflake (strongly preferred), SQL and SQL/Python stored procedures, dbt or other ETL tools, ELT/ETL design patterns, and orchestration (Airflow or similar).
Senior Data Platform Engineer / SDE Cambia Health Solutions IncSenior Data Platform Engineer / SDEFargo, ND$101,000–$134,000 / yearWhat You Bring to Cambia: Preferred Key Experience: Experienced technical lead with a strong background in building and optimizing data pipelines, excellent SQL skills, and hands‑on expertise with Snowflake, dbt, and modern ELT practices. Skills and Attributes (Not limited to): Deep expertise with Snowflake (strongly preferred), SQL and SQL/Python stored procedures, dbt or other ETL tools, ELT/ETL design patterns, and orchestration (Airflow or similar).
Risk Adjustment Campaign Associate (Risk Adjustment Coordinator) Cambia Health Solutions IncRisk Adjustment Campaign Associate (Risk Adjustment Coordinator)Salt Lake City, UTWhat You Bring to Cambia: Qualifications: Risk Adjustment Campaign Associate would have a Bachelor's Degree in business, project management, healthcare, or related field and at least 2 years of experience in a project support role (preferably within health care), or equivalent combination of education and experience. As a member of the Risk Adjustment team, our Risk Adjustment Campaign Associate works with the Risk Adjustment operations team on on-going activities related to Medicare Advantage and Commercial risk adjustment campaigns.
Director Clinical Operations and Medical Policy Cambia Health Solutions IncDirector Clinical Operations and Medical PolicySalt Lake City, UTDemonstrated knowledge of the following: Health Plan and benefit design structures and application; Medicare/CMS regulations and applicability in administering the Medicare Product; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; Knowledge of health care coding and payment systems (such as ICD-10, CPT, HCPCS, NDC); Compliance related activities, legislative and regulatory activities, health insurance operations, or legal research helpful; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA. These activities include services pertaining to: evidence reviews of medications, formulary development, Pharmacy and Therapeutics (P&T) Committee support, medication use policy development, the Medication Policy Group (MPG), clinical prior authorization, implementation of utilization management activities, guidance for clinical edit coding for prescription claims processor or medical claims system, medication pipeline monitoring, medication trend management, and consultation and guidance on medication-related issues.
Director Clinical Operations and Medical Policy Cambia Health Solutions IncDirector Clinical Operations and Medical PolicyFargo, NDDemonstrated knowledge of the following: Health Plan and benefit design structures and application; Medicare/CMS regulations and applicability in administering the Medicare Product; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; Knowledge of health care coding and payment systems (such as ICD-10, CPT, HCPCS, NDC); Compliance related activities, legislative and regulatory activities, health insurance operations, or legal research helpful; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA. These activities include services pertaining to: evidence reviews of medications, formulary development, Pharmacy and Therapeutics (P&T) Committee support, medication use policy development, the Medication Policy Group (MPG), clinical prior authorization, implementation of utilization management activities, guidance for clinical edit coding for prescription claims processor or medical claims system, medication pipeline monitoring, medication trend management, and consultation and guidance on medication-related issues.
Director Clinical Operations and Medical Policy Cambia Health Solutions IncDirector Clinical Operations and Medical PolicyBurlington, WADemonstrated knowledge of the following: Health Plan and benefit design structures and application; Medicare/CMS regulations and applicability in administering the Medicare Product; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; Knowledge of health care coding and payment systems (such as ICD-10, CPT, HCPCS, NDC); Compliance related activities, legislative and regulatory activities, health insurance operations, or legal research helpful; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA. These activities include services pertaining to: evidence reviews of medications, formulary development, Pharmacy and Therapeutics (P&T) Committee support, medication use policy development, the Medication Policy Group (MPG), clinical prior authorization, implementation of utilization management activities, guidance for clinical edit coding for prescription claims processor or medical claims system, medication pipeline monitoring, medication trend management, and consultation and guidance on medication-related issues.
Director Clinical Operations and Medical Policy Cambia Health Solutions IncDirector Clinical Operations and Medical PolicyPortland, ORDemonstrated knowledge of the following: Health Plan and benefit design structures and application; Medicare/CMS regulations and applicability in administering the Medicare Product; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; Knowledge of health care coding and payment systems (such as ICD-10, CPT, HCPCS, NDC); Compliance related activities, legislative and regulatory activities, health insurance operations, or legal research helpful; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA. These activities include services pertaining to: evidence reviews of medications, formulary development, Pharmacy and Therapeutics (P&T) Committee support, medication use policy development, the Medication Policy Group (MPG), clinical prior authorization, implementation of utilization management activities, guidance for clinical edit coding for prescription claims processor or medical claims system, medication pipeline monitoring, medication trend management, and consultation and guidance on medication-related issues.
Director Clinical Operations and Medical Policy Cambia Health Solutions IncDirector Clinical Operations and Medical PolicyLewiston, IDDemonstrated knowledge of the following: Health Plan and benefit design structures and application; Medicare/CMS regulations and applicability in administering the Medicare Product; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; Knowledge of health care coding and payment systems (such as ICD-10, CPT, HCPCS, NDC); Compliance related activities, legislative and regulatory activities, health insurance operations, or legal research helpful; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA. These activities include services pertaining to: evidence reviews of medications, formulary development, Pharmacy and Therapeutics (P&T) Committee support, medication use policy development, the Medication Policy Group (MPG), clinical prior authorization, implementation of utilization management activities, guidance for clinical edit coding for prescription claims processor or medical claims system, medication pipeline monitoring, medication trend management, and consultation and guidance on medication-related issues.
Temporary Customer Service Professional I Cambia Health Solutions IncTemporary Customer Service Professional IMedford, ORRemote$19–$22.25 / hour6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience. As the face of Cambia, our CSPs play multiple roles - listener, problem-solver, investigator and advocate - all in service of making our members' health journeys easier and days brighter.
Temporary Customer Service Professional I Cambia Health Solutions IncTemporary Customer Service Professional ILewiston, IDRemote$19–$22.25 / hour6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience. As the face of Cambia, our CSPs play multiple roles - listener, problem-solver, investigator and advocate - all in service of making our members' health journeys easier and days brighter.
Temporary Customer Service Professional I Cambia Health Solutions IncTemporary Customer Service Professional IPocatello, IDRemote$19–$22.25 / hour6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience. As the face of Cambia, our CSPs play multiple roles - listener, problem-solver, investigator and advocate - all in service of making our members' health journeys easier and days brighter.