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Cambia Health Solutions

Cambia Health Solutions is a nonprofit organization dedicated to changing healthcare through a “person-focused and economically sustainable system.” As an e

Utilization and Care Management Nurse

Location

Idaho + 3 moreAll locations: Idaho | Oregon | Utah | Washington

Posted

10 days ago

Salary

$34 - $56 / hour

Seniority

Mid Level

Bachelor Degree

Job Description

Utilization and Care Management Nurse

Cambia Health Solutions

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

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