Cambia Health Solutions

Clinical Pharmacist Consultant or Sr. DOE

Cambia Health Solutions · Full Time · 11 days ago

Cambia Health Solutions

🌎 United States 💵 $114K - $214K per year ⭐ 2-5 yrs exp 💼 Healthcare

Provide clinical pharmacy expertise to guide medication coverage decisions based on efficacy, safety, and affordability. Develop medication coverage policies, formulary monographs, and conduct peer-to-peer conversations with healthcare professionals.

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Payment Integrity Project Coordinator

Cambia Health Solutions · Full Time · 16 days ago

Cambia Health Solutions

🌎 United States 💵 $23.91 - $42.2 per hour ⭐ 2-5 yrs exp 💼 Product

Supports the initiation, planning, execution, and closing of payment integrity projects in alignment with Enterprise Project Management Office standards. Coordinates project schedules, budgets, and documentation while facilitating meetings and reporting status to leadership.

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Temporary Customer Service Professional I

Cambia Health Solutions · Full Time · a month ago

Cambia Health Solutions

🌎 United States 💵 $19 - $22.25 per hour ⭐ 0-2 yrs exp 💼 Support

Act as a guide and advocate for members and providers by answering inquiries regarding health insurance benefits, claims, and eligibility. Conduct research to resolve complex issues and provide accurate, compliant information to callers.

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Pharmacy Services Technician

Cambia Health Solutions · Full Time · a month ago

Cambia Health Solutions

🌎 United States 💵 $20.5 - $30.8 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Provides technical support for pharmacy benefits, reimbursement, and drug use issues without requiring clinical judgment. Manages formulary operational processes, including processing exception requests, prior authorizations, and auditing medication-related claims.

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VP of Business Optimization

Cambia Health Solutions · Full Time · a month ago

Cambia Health Solutions

🌎 United States 💵 $224K - $366K per year ⭐ 10+ yrs exp 💼 Others

Lead enterprise-level transformation by developing a 3-year strategic roadmap to optimize clinical and operational performance. Drive business process optimization and cost stewardship programs to ensure an economically sustainable healthcare system.

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Clinical RFP Coordinator

Cambia Health Solutions · Full Time · 2 months ago

Cambia Health Solutions

🌎 United States 💵 $76500 - $103K per year ⭐ 5-10 yrs exp 💼 Healthcare

The Clinical RFP Coordinator facilitates responses to RFPs and collaborates with various teams to ensure accurate representation of clinical products and services. They also maintain and evaluate sales material content and develop new content for communication projects.

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Assistant Director, Broker Strategy & Performance Management

Cambia Health Solutions · Full Time · 2 months ago

Cambia Health Solutions

🌎 United States 💵 $136K - $184K per year ⭐ 10+ yrs exp 💼 Finance

Oversee a team focused on maximizing value through broker distribution channels and managing compensation programs. Drive strategic initiatives to align broker performance with organizational objectives and provide insights to senior leadership.

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Integration Manager

Cambia Health Solutions · Full Time · 2 months ago

Cambia Health Solutions

🌎 United Kingdom, United States 💵 $148K - $201K per year ⭐ 10+ yrs exp 💼 Software Development

Lead the planning and execution of complex business integrations, translating deal rationale into actionable roadmaps and managing milestones from signing to stabilization. Coordinate cross-functional teams across IT, HR, Finance, and Operations to drive accountability and realize business synergies.

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Remote Care Management Nurse

Cambia Health Solutions · Full Time · 2 months ago

Cambia Health Solutions

🌎 United States 💵 $36.8 - $49.8 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Conduct comprehensive case management activities including assessment, planning, and monitoring to meet member healthcare needs. Collaborate with physician advisors and internal departments to resolve claims and improve quality of care outcomes.

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Risk Adjustment Auditor II

Cambia Health Solutions · Full Time · 4 months ago

Cambia Health Solutions

🌎 United States 💵 $68900 - $93150 per year ⭐ 2-5 yrs exp 💼 Finance

Risk Adjustment Auditors perform retrospective and prospective chart reviews to verify the accuracy and completeness of provider-reported diagnosis codes based on medical record documentation, ensuring accurate risk adjustment reporting. They also identify coding and documentation trends and collaborate with Provider Education Consultants to develop intervention strategies.

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