Supervisor Clinical Appeals

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

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.

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