Utilization Management – Inpatient Clinical Specialist

Cambia Health Solutions

. Receive, research, and take action on documentation and requests related to Inpatient Utilization Management cases .

Posted 10/1/2026full-timeRemote • United StatesJuniorMid-Level💰 $24 - $42 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Inpatient Utilization Management processes, including research, documentation, and compliance with regulatory standards. Proficient in communication and collaboration with healthcare professionals to ensure case accuracy and efficiency.

Highest-signal resume keywords

Clinical ExperienceUtilization ManagementMedical TerminologyMicrosoft OfficeCritical Thinking

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Inpatient Utilization ManagementHealthcare SystemsEMRsBillingClaimsCPT CodingDX CodingHCPCs CodingData EntryDocumentation

Soft Skills

Strong Communication SkillsOrganizationProblem-SolvingAdaptabilityConfidentiality

Tools & Technologies

Microsoft OfficeOutlookInternet Search

Certifications & Qualifications

CMACNA

Industry Keywords

Inpatient Hospital SettingRegulatory ComplianceQuality StandardsBCBSA StandardsAccreditation Standards

About the role

Key responsibilities & impact

Receive, research, and take action on documentation and requests related to Inpatient Utilization Management cases
Partner with licensed health professionals on appropriate actions and responses; role does not make clinical decisions
Research and review inpatient Utilization Management requests for completeness
Obtain necessary details and complete non-clinical tasks to close cases accurately and efficiently
Communicate with internal and external stakeholders, including providers and team members
Facilitate written notifications in compliance with regulatory and quality requirements
Manage UM activities to meet timeliness, production, quality, corporate, federal, state, BCBSA, and accreditation standards
Organize and maintain reference documents, policies, and procedures
Perform detailed research and problem-solving to ensure case accuracy and completeness
Identify opportunities to improve systems and workflows
Initiate referrals to adjacent teams as needed
Discuss discharge planning with providers as needed
Assist with systems testing when needed

Requirements

What you’ll need

High school diploma or equivalent
Clinical experience is required
At least 2 years of clinical experience preferred
CMA or CNA preferred
Clinical experience, preferably in an inpatient hospital setting
Strong oral and written communication skills
Computer skills including Microsoft Office, Outlook, and internet search
Experience with healthcare systems and documentation, EMRs, billing, and claims
Knowledge of medical terminology, anatomy, and coding, including CPT, DX, and HCPCs
Critical thinking, organization, data entry, and administrative skills
Ability to work independently with a high-volume caseload, prioritize tasks, meet deadlines, and work effectively in a team environment
Ability to adapt to changes in the healthcare insurance industry
Ability to maintain confidentiality
Wired internet connection; minimum 5Mb upload and 10Mb download speeds for work-from-home option
Personal mobile device required for MFA
Background check required

Benefits

Comp & perks

Competitive salary
Market-leading 401(k) with a significant company match
Bonus opportunities
Medical, dental and vision coverage for employees and eligible family members, including mental health benefits
Annual employer contribution to a health savings account
Generous paid time off varying by role and tenure
10 company-paid holidays
Market-leading retirement plan with company match and potential discretionary contribution based on company performance, with no vesting period
Up to 12 weeks of paid parental time off after 12 months of continuous service
Award-winning wellness programs that reward participation
Employee Assistance Fund
Commute and parking benefits
Work from home options for most roles
Employee resource groups
Cambia-supported community outreach programs