Cambia Health Solutions

Title: Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE Location: Oregon, Washington, Idaho or Utah United States Work Type: Remote, Part time Job ID: R-6603 Job Description: Hybrid role (3 days/week in office) at our Burlington, Renton, Spokane, Vancouver, Portland, Medford, Salt Lake City, Boise, Lewiston, or Fargo offices. Candidates must reside within commutable distance of that location or be willing to relocate. This is a part-time non-benefited position with a maximum of 12 hours per week. 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 physicians are living our mission to make health care easier and lives better. As a member of the Utilization Management (UM) team, our Associate Medical Director BH and UM Medical Directors provides leadership, and clinical oversight for behavioral health operations across all lines of business within the health plan, with a primary focus on behavioral health utilization management. Partners with leaders and staff across the organization to ensure policies, programs and strategies related to our members. Conducts case reviews requiring physician involvement and/or provides clinical expertise to others related to behavioral health case management, prior authorizations and appeals. Provides peer-to-peer consultations with providers - all in service of creating a person-focused health care experience. Are you a motivated and experienced medical professional looking for a new challenge? Do you have a passion for patient care and want to make a big difference in healthcare? Then this role may be the perfect fit. What You Bring to Cambia: Qualifications: - Licensed Physician with an MD or DO degree - Active, unrestricted license to practice medicine in one or more of our 4 states. - Board Certification in general psychiatry or child psychiatry required with preference for being board certified in both. - Qualification by training and experience to render clinical opinions about medical conditions, procedures, and treatments under review. - At least 3 years clinical experience. - Two years health plan medical utilization management and/or case management experience. - Equivalent combination of education and experience. - Must be located in one of our four states. Skills and Attributes: - In-depth knowledge of best practices related to medical care for a wide variety of behavioral health conditions. - Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to effectively manage patient care to improve outcomes. - Passion for population health, healthcare transformation and improving the experience of people with mental health issues. - Strong communication and facilitation skills with internal staff and external stakeholders, including the ability to resolve issues and seek optimal outcomes. - Proven ability to develop and maintain positive working relationships with community and provider partners. - Knowledge of the health insurance industry, state and federal regulations (including Parity Legislation/Regulations), provider reimbursement methods and evolving accountable care and payment models is preferred. - Experience conducting medical case reviews for utilization and/or case management is strongly preferred. - Detail-oriented with orientation to the application of data and metrics in managing health, quality and program effectiveness. - Leadership experience with demonstrated ability to effectively build relationships, work with others and lead people and project teams. What You Will Do at Cambia: - Develops 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. - Operational Leadership and Oversight: Oversees the development of effective operational policies, procedures, and standards for an integrated behavioral health program, monitors utilization and results, and implements process or system changes as needed. - 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. - Collaboration and Communication: Collaborates with the Executive Medical Director of Behavioral Health, leads/participates in teams for medical policy reviews and development, and discusses review determinations with providers to promote understanding of utilization management and quality improvement policies. - Industry Trends and Opportunities: Stays abreast of industry, medical, and technology trends, identifies and communicates new opportunities to enhance outcomes and the organization's reputation, and collaborates to implement actions to reduce medical cost trend. - Other roles as assigned. #LI-Hybrid Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history. Associate Medical Director - Oregon, Washington, Utah, and Idaho: The expected hiring range is $217,600 - $294,400, the full salary range is $204,000 - $333,000 and the bonus target is 25%. - North Dakota: The expected hiring range is $217,171.97 - $293,820.91 and the full salary range is $192,827.15 - $318,165.72. Medical Director - Oregon, Washington, Utah, and Idaho: The expected hiring range is $238,850 - $323,150, the full salary range is $224,000 - $366,000 and the bonus target is 30%. - North Dakota: The expected hiring range is $252,506.91 - $341,626.99, the full salary range is $224,201.29 - $369,932.61 and the bonus target is 20%. About Cambia 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. Why Join the Cambia Team? At Cambia, you can: - Work alongside diverse teams building cutting-edge solutions to transform health care. - Earn a competitive salary and enjoy generous benefits while doing work that changes lives. - Grow your career with a company committed to helping you succeed. - Give back to your community by participating in Cambia-supported outreach programs. - Connect with colleagues who share similar interests and backgrounds through our employee resource groups. We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more. In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: - Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. - Annual employer contribution to a health savings account. - Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. - Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). - Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). - Award-winning wellness programs that reward you for participation. - Employee Assistance Fund for those in need. - Commute and parking benefits. Learn more about our benefits. We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

Title: Strategy & Innovation Consultant Job Description: Strategy and Innovation Consultant Hybrid role (3 days/week in office) in our Portland, OR, Renton, WA, Salt Lake City, UT, Boise, ID or Fargo, ND offices. Candidates must reside within commutable distance of that location or be willing to relocate. 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 Strategy & Innovation Consultants is living our mission to make health care easier and lives better. As a member of the Corporate Strategy team, our Strategy & Innovation Consultants perform data-driven analyses, develop financial models, and translate complex business problems into clear, actionable recommendations - all in service of creating an economically sustainable health care system. Do you thrive on solving complex, ambiguous problems with data and structured thinking? Do you enjoy working at the intersection of strategy, analytics, and executive influence? Then this role may be the perfect fit. What You Bring to Cambia: Qualifications: - Bachelor's degree in Economics, Business, Math, Statistics, or related field; Master's degree preferred - Minimum of 5 years of professional experience in business strategy development, management consulting, healthcare strategy, or equivalent combination of education and experience Skills and Attributes: - Experience in strategy consulting, investment banking, private equity, or corporate strategy - Advanced proficiency in Excel, PowerPoint, and financial modeling - Strong written communication skills, including the ability to synthesize data and support clear recommendations - Quantitative and qualitative research capabilities - Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired - Experience in healthcare preferred - Experience with data analysis tools such as SQL, Python, R, Tableau, or Power BI preferred What You Will Do at Cambia: - Perform data-driven analyses and visualizations, translating findings into presentations tailored for appropriate audiences, including board-level and executive stakeholders - Structure complex business problems and develop hypothesis-driven approaches to solutions - Develop financial models and business cases to evaluate strategic initiatives - Resourcefully identify and leverage data to answer complex business questions - Collaborate with executives and department heads to understand and advance business objectives - Facilitate workshops and strategic planning sessions, building consensus among diverse stakeholder groups - Manage multiple workstreams simultaneously while maintaining high quality standards Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history. Oregon, Washington, Utah, and Idaho: The expected hiring range is $101,150- 136,830, the full salary range is $95,000-155,000 and the bonus target is 15%. North Dakota: The expected hiring range is $101,853-137,801 and the full salary range is $90,435-149,219. About Cambia 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. Why Join the Cambia Team? At Cambia, you can: - Work alongside diverse teams building cutting-edge solutions to transform health care. - Earn a competitive salary and enjoy generous benefits while doing work that changes lives. - Grow your career with a company committed to helping you succeed. - Give back to your community by participating in Cambia-supported outreach programs. - Connect with colleagues who share similar interests and backgrounds through our employee resource groups. We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more. In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: - Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. - Annual employer contribution to a health savings account. - Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. - Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). - Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). - Award-winning wellness programs that reward you for participation. - Employee Assistance Fund for those in need. - Commute and parking benefits. Learn more about our benefits. We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

Role Description Work from home within Oregon, Washington, Idaho or Utah. Candidates must be available to work Pacific Standard Time (PST) hours irrespective of their physical location. Every day, Cambia’s dedicated team of Pharmacy Consultants are living our mission to make health care easier and lives better. As a member of the Pharmacy Services team, our Clinical Pharmacist Consultants provide professional and clinical pharmacy expertise in making or guiding clinical decisions based on best practices by creating and applying evidence-based medicine evaluations to determine the best quality medication choices that represent the best value in efficacy, safety and affordability. This may include: - Providing coverage recommendations for medications subject to prior authorization based on applicable medication coverage policies and member benefit contracts. - Serving as a resource for other staff. - Assisting in planning, developing, and implementing clinical strategies with respect to formulary management, drug utilization management, and peer-to-peer conversations. - Development of position papers, medication coverage policies, formulary monographs and class reviews, cross-functional projects, and/or initiatives related to the provision of pharmacy benefits that impact safety, quality and affordability. Do you want to impact medication safety and affordability on a larger scale? Ready to collaborate on cross-functional projects that shape pharmacy benefits? Then this role may be the perfect fit. Qualifications - Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) or related field. - Minimum 3-5 years of experience in clinical acute care/hospital setting or equivalent combination of education and experience. - Pharmacy license. Successful completion of a pharmacy residency or advanced degree in health-related field preferred. Must be an active and unrestricted licensed pharmacist in state of practice. - Strong clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge in a clinical care setting. - Excellent verbal and written communication skills; strong business analytical skills and abilities; strong project management and coordination ability. - Ability to work independently, to prioritize work, meet deadlines and achieve operational goals. - Demonstrated success in managing professional relationships in a managed care system, medical group, hospital, or related organizations. - Ability to collaborate as part of cross functional teams, to improve clinical programs, enhance processes and share clinical information. - Knowledge of pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA. - Strong knowledge of health care economics and financing; health care/pharmaceutical industry dynamics; and pharmacy/provider service reimbursement of medications. - Knowledge of Health Plan and benefit design structures and application; Medicare/CMS regulations and applicability in administering the Medicare Product; health care coding and payment systems (such as ICD-9, CPT, HCPCS, NDC). - Strong knowledge of compliance related activities, legislative and regulatory activities, health insurance operations, and legal issues. - Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired. Requirements - Provide clinical decision-making based on best practices in applying evidence-based medicine process in determining medications that have best value for efficacy and safety. - Provide coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts. - Complete peer-to-peer conversations with external healthcare professionals. - Develop position papers, medication coverage policies, formulary monographs and class reviews, and formulary coverage recommendations based on critical appraisal of the scientific literature and input from practicing physicians to ensure optimal clinical outcomes at most cost-effective level. - Present and/or communicate clinical positions on medication analysis in clear, concise manner. Benefits - Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. - Annual employer contribution to a health savings account. - Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. - Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). - Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). - Award-winning wellness programs that reward you for participation. - Employee Assistance Fund for those in need. - Commute and parking benefits.

Role Description Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Every day, Cambia’s dedicated team of Payment Integrity Project Coordinator is living our mission to make health care easier and lives better. As a member of the Payment Integrity team, our Payment Integrity Project Coordinator supports project initiation, planning, execution, control, and closing – all in service of making our members’ health journeys easier. Do you have a passion for keeping projects organized and on track? Do you thrive in collaborative environments where attention to detail and clear communication are essential? Then this role may be the perfect fit. Qualifications - Bachelor's degree in business, project management, healthcare, or related field. - At least two years of experience in a project support role, or equivalent combination of education and experience. - Demonstrated experience in project management methods and techniques and development life cycle disciplines. - Ability to manage small, well-defined projects with minimum supervision. - Experience with Microsoft Office suite of tools. - Certificate or training in Project Management a plus. - Ability to be highly detail-oriented. - Ability to work effectively with minimum supervision. - Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired. - Demonstrated ability to leverage AI tools and resources to drive efficiency and innovation within area of expertise. Requirements - Supports project management activities in accordance with the Enterprise Project Management Office policies and standards. - Supports the development and maintenance of project and program plans, including project schedules and budgets, and plans for project quality, resources, communications, and risks. - Assists with monitoring and controlling the execution of project tasks against the project plans. - Assists with the tracking and management of project costs, resources, issues, changes, and risks. - Supports the preparation of status reports and other project reports and presentation of information to organizational leadership, project teams, and client/customer groups. - Coordinates and facilitates project meetings. - Monitors project documentation for compliance with standards. - Maintains the overall project documentation library ensuring that all documentation is established, maintained, and retained as necessary in project databases. - Assists with the monitoring, quality assurance, and reporting of project deliverables. Benefits - Medical, dental, and vision coverage for employees and their eligible family members, including mental health benefits. - Annual employer contribution to a health savings account. - Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. - Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). - Up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption). - Award-winning wellness programs that reward you for participation. - Employee Assistance Fund for those in need. - Commute and parking benefits.

Title: Strategic Finance Analyst Ld or Sr locations Portland, OR Salt Lake City, UT Medford, OR Lewiston, ID Boise, ID Burlington, WA Vancouver, WA Utah Renton, WA Oregon Washington Spokane, WA Idaho time type Full time job requisition id R-6514 Job Description: Hybrid role (3 days/week in office) at our Portland, Medford, Fargo, Burlington, Vancouver, Renton, Boise, Lewiston or Salt Lake City offices. Candidates must reside within commutable distance of that location. Who We Are Looking For: Every day, Cambia’s dedicated team of Strategic Financial Analysts is living our mission to make health care easier and lives better. As a member of the Finance team, our Strategic Financial Analysts serve as a trusted finance business partner in the area(s) of support, by providing financial guidance and support; builds budgets, forecasts, conducts variance analysis and reporting; prepares financial analysis and support such as cost-benefit, return on investment and capital resource analysis for new business opportunities, proposals, contracts, or product development; supports cost savings and process improvement efforts; provides financial governance and oversight – all in service of creating a person-focused health care experience. Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit. What You Bring to Cambia: Qualifications: Strategic Financial Analyst Senior typically requires a bachelor's degree in business, accounting, economics or statistics. CPA, CMA, MBA or ASA, along with health insurance experience preferred plus 7-9 years of experience or equivalent combination of education and experience. Strategic Financial Analyst Lead typically requires a bachelor's degree in business, accounting, economics or statistics. CPA, CMA, MBA or ASA, along with health insurance experience preferred plus 12 or more years of responsible experience and completion of certifications required in area of specification or equivalent combination of education and experience. Skills and Attributes: Senior Strategic Financial Analyst - Thorough knowledge of applicable statutes, policies and procedures. Provides input and influence on policies and procedures. - Conceptualizes solutions and develops alternatives to complex problems. - Broad perspective applied to decision making. - Articulates complex and/or complicated issues with a high level of skill, including listening and influence. - Proven and thorough knowledge of business principles, theories, and concepts and deep knowledge of multiple business areas. - Highly sought after by the business to provide a wide depth and breadth of consultation, education, and influence in the business. - Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired Lead Strategic Financial Analyst - Highly knowledgeable and provides education and consultation on a wide variety of applicable statutes, policies and procedures. - Conceptualizes solutions to complex problems; readily anticipates problems and identifies solutions. - Comprehensive perspective applied to decision making. - Repeated success with communicating the most complex issues with great skill and precision - at all levels in the organization. - Comprehensive knowledge and expertise of business/healthcare principles and concepts in specialty area and high level of proficiency across multiple business functions. - Highly sought after by the business to provide a wide depth and breadth of consultation, education, and influence in the business. - Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired What You Will Do at Cambia: Senior Strategic Financial Analyst - Delivers highly effective presentations to all levels of the organization. Has a demonstrated understanding of how to highlight the most important points to a variety of stakeholders. - Develops complex financial models and analysis using advanced analytical techniques and financial systems; provides business with solid alternatives to complex and unusual issues. - Plans, organizes, schedules, coordinates and monitors large work streams involving one functional area or smaller tasks involving multiple areas. Guides the work of analysts and others. - Provides training or consulting expertise to other departments, analysts and external stakeholders. - Effectively advises and influences the business on a wide variety of business issues; leads positive change internally; function independently with limited supervision; mentors analysts and others. Lead Strategic Financial Analyst - Delivers presentations on complex issues, and at all levels in the organization, with a level of knowledge and influence throughout the business. - Develops complex financial models and analysis using advanced analytical techniques and financial systems; provides business with solid alternatives to broad, complex and unusual issues; readily modifies or adjusts techniques to meet new situations. - Plans, organizes, schedules, coordinates and monitors large, complex tasks involving multiple functional areas. Guides work of analysts and others. - Regularly leads efforts and initiatives with a high level of influence on decision making across the company; leads positive change, both internally and externally; functions independently; mentors analysts and others. Work Environment - No unusual working conditions. - Work primarily performed in office environment. Compensation Ranges: Senior Strategic Financial Analyst - Oregon, Washington, Utah, and Idaho: The expected hiring range for a Strategic Finance Analyst Sr is $101,200.00 – $136,900.00, the full salary range is $95,000.00 – $155,000.00 and the bonus target is 15%. - North Dakota: The expected hiring range is $90,906.65 - $122,991.35, the full salary range is $80,716 - $133,182. Lead Strategic Financial Analyst - Oregon, Washington, Utah, and Idaho: The expected hiring range for a Strategic Finance Analyst Ld is $121,600.00 – $164,500.00, the full salary range is $114,000.00 – $186,000.00 and the bonus target is 15%. - North Dakota: The expected hiring range is $114,251.05 – 154,574.95, the full salary range is $101,444 – $167,383. About Cambia 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. Why Join the Cambia Team? At Cambia, you can: - Work alongside diverse teams building cutting-edge solutions to transform health care. - Earn a competitive salary and enjoy generous benefits while doing work that changes lives. - Grow your career with a company committed to helping you succeed. - Give back to your community by participating in Cambia-supported outreach programs. - Connect with colleagues who share similar interests and backgrounds through our employee resource groups. We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more. In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: - Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. - Annual employer contribution to a health savings account. - Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. - Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). - Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). - Award-winning wellness programs that reward you for participation. - Employee Assistance Fund for those in need. - Commute and parking benefits. We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb. We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

Role Description Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Every day, Cambia's dedicated Performance Integrity Analysts I are living our mission to make health care easier and lives better. As a member of the Quality Training and Documentation team, our Performance Integrity Analysts: - Audit high dollar claims according to established provider contracts, pricing methodologies, core systems, procedures, and audit guidelines. - Submit findings to accountable business owners for review and acceptance. - Validate that required corrective actions have been completed. - Provide feedback and recommendations for quality improvement to management. Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit. Qualifications - Two years of experience as a claim processor, or an equivalent combination of education and job-related experience, depending on current business needs. - Ability to understand and apply mathematical concepts. - Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel, and Outlook. - Knowledge of claims coding, and applicable systems including Facets, eVIPS, and Radar. - Audit experience desirable. - Ability to organize and prioritize work. - Must be detail-oriented and self-motivated. - Must be able to communicate effectively both orally and in writing. Requirements - Audit claims for accuracy according to audit policies, procedures, and guidelines. - Encourage team and individual contributions toward the company's quality initiatives and improvement efforts. - Participate in team efforts to develop or update department standards. - Provide feedback on department's performance in reaching service and performance level goals. - Remain continuously current on changes and/or additions to all other applicable departments' policies, procedures, and guidelines. - Thoroughly investigate problems. - Identify and report inconsistencies or ambiguities in manuals, policies, and guidelines. Benefits - Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. - Annual employer contribution to a health savings account. - Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. - Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). - Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). - Award-winning wellness programs that reward you for participation. - Employee Assistance Fund for those in need. - Commute and parking benefits.

Title: Community and Culture Program Manager Location: Salt Lake City, Fargo, Boise, Lewiston, Portland or Renton offices United States Full time job requisition id: R-6627 Job Description: This is a hybrid role (3 days/week in office) at our Salt Lake City, Fargo, Boise, Lewiston, Portland or Renton offices. Candidates must reside within commutable distance of that location or be willing to relocate. 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 team is living our mission to make health care easier and lives better. As part of the Human Resources team, our Culture & Community Program Manager plays a hands-on role in bringing that mission to life in the everyday experiences of our employees. This role sits at the intersection of culture, inclusion, employee connection, and community. At Cambia, inclusion isn't the responsibility of a single role - it's an organizational commitment. This position helps translate Cambia's commitment to inclusion and connection into employee programs, experiences, and practices across the organization. We're looking for someone who believes belonging isn't a program - it's how we work. If you're energized by building community, connecting people to purpose, and making the workplace feel like somewhere worth showing up, this role is for you What You Bring to Cambia Qualifications: - 3-5 years of experience in employee engagement, culture, inclusion, talent, communications, or related HR/people functions, with experience embedding inclusive practices into employee or talent programs - Experience managing programs or events with multiple stakeholders and moving parts - Familiarity with Employee Resource Groups, employee communities, or volunteer/foundation partnerships a plus - Strong organizational and project management skills, with the ability to manage multiple priorities and coordinate employee programs with consistency and care Skills and Attributes: - Ability to translate culture and inclusion priorities into practical people practices and employee experiences across the talent lifecycle - Strong understanding of how inclusive practices show up in hiring, onboarding, development, engagement and leadership behavior - Strong relationship-building skills, with the ability to work effectively across teams and foster inclusive employee experiences - Ability to build credibility and work effectively across levels, from frontline employees to senior leaders - Strong execution skills, with attention to detail and the ability to connect day-to-day work to broader culture and business priorities - Demonstrated commitment to inclusive workplace practices and employee engagement - Strong communicator - written, verbal, and in a room full of people What You Will Do: ERG & Employee Community Support - Serve as the primary HR point of contact and program manager for Cambia's Employee Resource Groups - Support ERG leaders with programming, logistics, development resources, and visibility - Help grow and sustain employee clubs and communities across the organization Culture Integration & Belonging - Lead program management for culture integration initiatives that connect employees across teams, locations, and backgrounds - Support return-to-office efforts by creating meaningful in-office experiences that foster connection - not just presence - Drive expansion of Blue Squad and similar community-building programs to all Cambia office locations Events & Experiences - Manage planning and execution of employee engagement events, - Partner with internal teams to design experiences that reflect and reinforce Cambia's culture and values Community Impact - Partner with the Cambia Foundation to identify and build community-based cultural opportunities that extend our values beyond our walls - Connect employee volunteerism and community engagement to the broader culture strategy Cross-Functional Collaboration - Partner with Talent, HRBPs, and Communications to integrate culture and inclusion into key talent practices and employee experience moments - Help embed belonging and inclusive leadership principles into how Cambia hires, develops, recognizes, and supports employees - Work closely with HR Business Partners, Communications, and senior leaders to align culture efforts with business priorities - Serve as a resource and thought partner to leaders who want to strengthen culture within their teams #LI-Hybrid Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history. - Oregon, Washington, Utah, and Idaho: The expected hiring range is $84,200 - $113,900 and the full salary range is $79,000 - $129,000. - North Dakota: The expected hiring range is $81,679.31 - $110,507.30  and the full salary range is $72,523.20 - $119,663.39. - The bonus target for this position is 10%. About Cambia 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. Why Join the Cambia Team? At Cambia, you can: - Work alongside diverse teams building cutting-edge solutions to transform health care. - Earn a competitive salary and enjoy generous benefits while doing work that changes lives. - Grow your career with a company committed to helping you succeed. - Give back to your community by participating in Cambia-supported outreach programs. - Connect with colleagues who share similar interests and backgrounds through our employee resource groups. We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more. In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: - Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. - Annual employer contribution to a health savings account. - Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. - Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). - Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). - Award-winning wellness programs that reward you for participation. - Employee Assistance Fund for those in need. - Commute and parking benefits. Learn more about our benefits. We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb. We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

Role Description Utilization and Care Management Nurse Work from home within Oregon, Washington, Idaho or Utah. As a member of the Clinical Services team, our Utilization and Care Management Nurses provide: - Utilization and care management (prospective, concurrent, retrospective review, post-discharge care coordination) - Support to meet the member’s specific healthcare needs - Promotion of quality and cost-effective outcomes - Appropriate payment for services Are you a Nurse who has a passion for healthcare? Are you ready to take your career to the next level and make a real difference in the lives of our members? Then this role may be the perfect fit. Qualifications - Associate or Bachelor’s Degree in Nursing or related field - 3 years of case management, utilization management, disease management, auditing or retrospective review experience - Equivalent combination of education and experience - Must have licensure or certification in a state or territory of the United States that allows the professional to conduct an assessment independently - At least 3 years (or full-time equivalent) of direct clinical care - May need to have licensure in all four states served by Cambia: Idaho, Oregon, Utah, Washington - Must have at least one of the following: - Bachelor’s degree (or higher) in a health or human services-related field (psychiatric RN or Masters’ degree in Behavioral Health preferred for behavioral health) - Registered nurse (RN) license (must have a current unrestricted RN license for medical care management) Requirements - Knowledge of health insurance industry trends, technology and contractual arrangements - General computer skills (including use of Microsoft Office, Outlook, internet search) - Familiarity with health care documentation systems - Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired - Strong verbal, written and interpersonal communication and customer service skills - Ability to interpret policies and procedures and communicate complex topics effectively - Strong organizational and time management skills with the ability to manage workload independently - Ability to think critically and make decisions within individual role and responsibility Benefits - Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits - Annual employer contribution to a health savings account - Generous paid time off varying by role and tenure in addition to 10 company-paid holidays - Market-leading retirement plan including a company match on employee 401(k) contributions - Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave) - Award-winning wellness programs that reward you for participation - Employee Assistance Fund for those in need - Commute and parking benefits

Role Description As a member of the Clinical Services team, the Utilization Management Inpatient (UM IP) Clinical Specialist receives, researches, and takes action related to documentation and requests from various sources related to Inpatient Utilization Management cases. The UM IP Clinical Specialist partners with licensed health professionals on appropriate actions and responses to support efficient and effective clinical reviews. - Utilize clinical knowledge and critical thinking to research and review IP UM requests. - Communicate effectively with internal and external stakeholders, including providers and team members. - Exhibit excellent time management skills to ensure timeliness of UM activities. - Organize and maintain reference documents, policies, and procedures. - Perform detailed research and problem-solve using sound decision-making skills. - Initiate referrals to adjacent teams as needed. - Discuss discharge planning with providers as needed. Qualifications - High school diploma or equivalent. - Clinical experience is required. - At least 2 years of clinical experience preferred. - CMA or CNA preferred. - Strong communication skills, both oral and written. - Computer skills, including Microsoft Office, Outlook, and internet search. - Knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCs). Requirements - Ability to work independently with a high volume case load. - Prioritize tasks, meet deadlines, and achieve operational standards. - Maintain confidentiality and focus on meeting customer needs. - Adapt to changes in the healthcare insurance industry. - Utilize strong organization, data entry, and administrative skills. Benefits - Medical, dental, and vision coverage for employees and their eligible family members, including mental health benefits. - Annual employer contribution to a health savings account. - Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. - Market-leading retirement plan including a company match on employee 401(k) contributions. - Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service). - Award-winning wellness programs that reward participation. - Employee Assistance Fund for those in need. - Commute and parking benefits.

Role Description Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Every day, Cambia’s dedicated team of Appeals Clinicians are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Appeals Clinician I utilizes clinical expertise to complete the clinical component of all appeal types to resolve member and/or provider appeals – all in service of making our members’ health journeys easier. What if your clinical expertise could advocate for patients beyond the bedside - shaping the outcomes that matter most to them? Are you an RN who finds yourself asking 'why' when a care decision doesn't feel right - and wishing you had the power to change it? Then this role may be the perfect fit. Qualifications - Bachelor's Degree in Nursing and 3 years of experience in a clinical setting, health insurance, coding/claims review, case management or equivalent combination of education and experience. - Active licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical care. - Registered nurse (RN) license (must have a current unrestricted RN license within either Oregon, Washington, Idaho or Utah). Requirements - Demonstrated competency in claim review and experience using billing and claims forms. - Proven knowledge of medical and surgical procedures and other healthcare practices. - Proven competency to apply clinical expertise to ensure compliance with medical policy. - Familiarity regarding rules applied to appeals by accrediting bodies, state and federal governments, and employer groups. - Knowledge in reading and interpreting medical records, patient data, and member benefits with an ability to communicate complex topics effectively with clinical and non-clinical staff. - Knowledge of personal computer software, such as Microsoft Word, Excel, PowerPoint and Access. - Ability to prepare and present clear and concise written narratives and decisions. - Knowledge of CPT, ICD-9 and HCPCS coding and MCG (Milliman Care Guidelines). - Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired. Benefits - Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. - Annual employer contribution to a health savings account. - Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. - Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). - Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). - Award-winning wellness programs that reward you for participation. - Employee Assistance Fund for those in need. - Commute and parking benefits.