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.
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.
Manager Clinical Pharmacy Quality and Affordability Programs Cambia Health Solutions IncManager Clinical Pharmacy Quality and Affordability ProgramsBoise, ID$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.
Payment Integrity Nurse I Cambia Health Solutions IncPayment Integrity Nurse ISpokane, 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 IBoise, 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 ISalem, 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.
Benefit Contrct Anlyst Cambia Health Solutions IncBenefit Contrct AnlystMedford, ORNegotiates and coordinates with internal and external business partners to develop, write, revise, and coordinate group and member benefit booklets, contracts, policies, summaries of benefit coverage, and all other regulatory documents for Individual, Small Group, Large Group, Administrative Services Only, Medicare Supplemental, Dental and Vision plans. A BCA develops benefit language, collaborates with Legal and Product, coordinates the filing of regulatory documents with state insurance divisions, analyzes insurance division objections, organizes responses and completes filing resubmission functions - all in service of creating a person-focused health care experience.
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 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.
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.
Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE Cambia Health Solutions IncAssociate Medical Director Behavioral Health or Utilization Management Medical Director DOEFargo, ND$217,171.97–$293,820.91 / yearDevelops and Implements Behavioral Health Policies and Programs: Assists in developing high-quality, market-competitive behavioral health medical policies and programs, and provides leadership in developing short and long-range plans, goals, and objectives for integrated utilization management. Subject Matter Expert and Clinical Leadership: Serves as a subject matter expert on behavioral health, provides medical advice, oversight, and leadership for staff, and ensures members receive safe, effective, and cost-efficient services.
Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE Cambia Health Solutions IncAssociate Medical Director Behavioral Health or Utilization Management Medical Director DOEMedford, OR$217,171.97–$293,820.91 / yearDevelops and Implements Behavioral Health Policies and Programs: Assists in developing high-quality, market-competitive behavioral health medical policies and programs, and provides leadership in developing short and long-range plans, goals, and objectives for integrated utilization management. Subject Matter Expert and Clinical Leadership: Serves as a subject matter expert on behavioral health, provides medical advice, oversight, and leadership for staff, and ensures members receive safe, effective, and cost-efficient services.
Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE Cambia Health Solutions IncAssociate Medical Director Behavioral Health or Utilization Management Medical Director DOEBend, OR$217,171.97–$293,820.91 / yearDevelops and Implements Behavioral Health Policies and Programs: Assists in developing high-quality, market-competitive behavioral health medical policies and programs, and provides leadership in developing short and long-range plans, goals, and objectives for integrated utilization management. Subject Matter Expert and Clinical Leadership: Serves as a subject matter expert on behavioral health, provides medical advice, oversight, and leadership for staff, and ensures members receive safe, effective, and cost-efficient services.
Cost Accountant III, IV or Senior Cambia Health Solutions IncCost Accountant III, IV or SeniorFargo, ND$59,000–$97,000 / yearAssists, supports, trains and directs Accountants I, II and III in daily activities, including the preparation of monthly balance sheet account reconciliations, analyses, journal entries, financial reports, and collection of data, including coordination with other Company departments to resolve inaccuracies or discrepancies as necessary. Provides support, assistance and training to Accountants I and II and III in their preparation of monthly balance sheet account reconciliations, analyses, journal entries, financial reports, and collection of data, including coordination with other Company departments to resolve inaccuracies or discrepancies as necessary.
Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE Cambia Health Solutions IncAssociate Medical Director Behavioral Health or Utilization Management Medical Director DOEVancouver, WARemote$217,171.97–$293,820.91 / yearDevelops and Implements Behavioral Health Policies and Programs: Assists in developing high-quality, market-competitive behavioral health medical policies and programs, and provides leadership in developing short and long-range plans, goals, and objectives for integrated utilization management. Subject Matter Expert and Clinical Leadership: Serves as a subject matter expert on behavioral health, provides medical advice, oversight, and leadership for staff, and ensures members receive safe, effective, and cost-efficient services.
Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE Cambia Health Solutions IncAssociate Medical Director Behavioral Health or Utilization Management Medical Director DOESalem, ORRemote$217,171.97–$293,820.91 / yearDevelops and Implements Behavioral Health Policies and Programs: Assists in developing high-quality, market-competitive behavioral health medical policies and programs, and provides leadership in developing short and long-range plans, goals, and objectives for integrated utilization management. Subject Matter Expert and Clinical Leadership: Serves as a subject matter expert on behavioral health, provides medical advice, oversight, and leadership for staff, and ensures members receive safe, effective, and cost-efficient services.
AI Scientist Senior II Cambia Health Solutions IncAI Scientist Senior IIPortland, OR$148,000–$196,000 / yearThis position applies deep expertise in advanced analytical tools such as generative AI, machine learning, deep learning, optimization, and statistical modeling to solve complex, high-impact business problems in the healthcare payer domain. What You Bring to Cambia: Qualifications: The AI Scientist Sr II would have a degree (masters or PhD preferred) in a strongly a strongly quantitative field such as Computer Science, Statistics, Applied Mathematics, Physics, Operations Research, Bioinformatics, or Econometrics, and typically at least 12 years of related work experience.
AI Scientist Senior II Cambia Health Solutions IncAI Scientist Senior IIBoise, ID$148,000–$196,000 / yearThis position applies deep expertise in advanced analytical tools such as generative AI, machine learning, deep learning, optimization, and statistical modeling to solve complex, high-impact business problems in the healthcare payer domain. What You Bring to Cambia: Qualifications: The AI Scientist Sr II would have a degree (masters or PhD preferred) in a strongly a strongly quantitative field such as Computer Science, Statistics, Applied Mathematics, Physics, Operations Research, Bioinformatics, or Econometrics, and typically at least 12 years of related work experience.
Cost Accountant III, IV or Senior Cambia Health Solutions IncCost Accountant III, IV or SeniorSalt Lake City, UT$59,000–$97,000 / yearAssists, supports, trains and directs Accountants I, II and III in daily activities, including the preparation of monthly balance sheet account reconciliations, analyses, journal entries, financial reports, and collection of data, including coordination with other Company departments to resolve inaccuracies or discrepancies as necessary. Provides support, assistance and training to Accountants I and II and III in their preparation of monthly balance sheet account reconciliations, analyses, journal entries, financial reports, and collection of data, including coordination with other Company departments to resolve inaccuracies or discrepancies as necessary.
AI Scientist Senior II Cambia Health Solutions IncAI Scientist Senior IISpokane, WA$148,000–$196,000 / yearThis position applies deep expertise in advanced analytical tools such as generative AI, machine learning, deep learning, optimization, and statistical modeling to solve complex, high-impact business problems in the healthcare payer domain. What You Bring to Cambia: Qualifications: The AI Scientist Sr II would have a degree (masters or PhD preferred) in a strongly a strongly quantitative field such as Computer Science, Statistics, Applied Mathematics, Physics, Operations Research, Bioinformatics, or Econometrics, and typically at least 12 years of related work experience.