Cambia Health Solutions

Performance Integrity Analyst I

Cambia Health Solutions · Full Time · 6 days ago

Cambia Health Solutions

🌎 United States 💵 $19.2 - $26.8 per hour ⭐ 2-5 yrs exp 💼 Others

Audit high-dollar claims based on provider contracts and pricing methodologies to ensure accuracy. Provide feedback for quality improvement and validate that corrective actions are completed by business owners.

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Temporary Customer Service Professional I

Cambia Health Solutions · Full Time · 10 days 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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Utilization and Care Management Nurse

Cambia Health Solutions · Full Time · 15 days ago

Cambia Health Solutions

🌎 United States 💵 $34.2 - $55.7 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Conduct utilization management reviews to ensure medical necessity and compliance with care standards. Coordinate healthcare needs and gaps for members during the transition from facility discharge to 30 days post-discharge.

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Utilization Management Inpatient Clinical Specialist

Cambia Health Solutions · Full Time · 18 days ago

Cambia Health Solutions

🌎 United States 💵 $24.4 - $42.2 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Research and review inpatient utilization management requests to ensure documentation completeness and accuracy. Collaborate with licensed health professionals and stakeholders to facilitate efficient clinical reviews and regulatory compliance.

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Pharmacy Services Technician

Cambia Health Solutions · Full Time · 18 days 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 · 21 days 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 · a month 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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Medical Policy Research Analyst Intern

Cambia Health Solutions · Full Time · a month ago

Cambia Health Solutions

🌎 United States 💵 $22 - $27 per hour ⭐ 0-2 yrs exp 💼 Healthcare

The intern will research, appraise, and summarize scientific literature and clinical guidelines to support the development of medical policies. They will also document research processes and present policy recommendations to the Medical Policy Workgroup.

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Assistant Director, Broker Strategy & Performance Management

Cambia Health Solutions · Full Time · a month 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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Clinical Pharmacist Consultant

Cambia Health Solutions · Full Time · a month ago

Cambia Health Solutions

🌎 United States 💵 $121K - $164K per year ⭐ 2-5 yrs exp 💼 Healthcare

The Clinical Pharmacist Consultant applies evidence-based medicine to guide clinical decisions, manage medication coverage policies, and conduct prior authorization reviews. They also develop formulary strategies and collaborate with cross-functional teams to improve the safety, quality, and affordability of pharmacy benefits.

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Integration Manager

Cambia Health Solutions · Full Time · a month 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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VP of Stop-Loss Underwriting

Cambia Health Solutions · Full Time · a month ago

Cambia Health Solutions

🌎 United States 💵 $238K - $323K per year ⭐ 10+ yrs exp 💼 Others

Manage the stop-loss book of business risk selection and classification to achieve growth and profitability objectives. Lead a multidisciplinary team of underwriters and analysts while overseeing underwriting guidelines and regulatory filings.

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Remote Care Management Nurse

Cambia Health Solutions · Full Time · a month 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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