Care Management Clinician

Cambia Health Solutions, Inc.; Provo (UT); Remote; USD 44,000 - 72,000; Full time

Job summary

Cambia Health Solutions, Inc. is seeking a Care Management Clinician to provide clinical care management, including case management, disease management, and care coordination, primarily from a remote location.

The role emphasizes independent workload management, policy adherence, and collaboration with physician advisors to ensure quality care.

Qualifications

• Associate or Bachelor's degree in Nursing or related field with 3 years of relevant experience.
• Current licensure in a US state to conduct assessments; 3+ years of direct clinical care.
• URAC certification or RN license or related degree in healthcare.

Responsibilities

• Perform essential case management activities—assessment, planning, implementation, coordination, monitoring, and evaluation.
• Apply clinical expertise to ensure compliance with medical policy and standards.
• Consult with physician advisors for appropriate determinations.
• Collaborate with other departments to resolve claims and quality issues.
• Identify problems and participate in quality improvement efforts.
• Respond to members, providers, and regulatory bodies while protecting confidentiality.
• Document and prioritize assignments to meet timelines.

Skills

Health insurance knowledge

Computer skills

Communication skills

Policy interpretation

Time management

Critical thinking

AI tools experience

Education

Associate or Bachelor’s Degree in Nursing or related field

RN license or equivalent licensure

URAC certification or related degree

Tools

Microsoft Office

Outlook

Healthcare documentation systems

Job description

Care Management Clinician

Work from home within Idaho, Oregon, Utah, and Washington. Preference will be given to current employees and candidates who reside in 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 Care Management Clinician is living our mission to make health care easier and lives better. As a member of the Care Management team, our Care Management Clinician provides clinical care management (such as case management, disease management, and/or care coordination) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes – all in service of making our members’ health journeys easier.

Do you have strong organization and time management skills? Do you have a passion for serving others and learning new things? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Care Management Clinician would have a/an Associate or Bachelor's Degree in Nursing or related field and 3 years of case management, utilization management, disease management, or behavioral health case management experience or equivalent combination of education and experience.
• Must have 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.
• Must have at least one of the following: Certification as a case manager from the URAC-approved list of certifications; or Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or Master's degree in Behavioral Health preferred for behavioral health care management); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management).

Skills and Attributes:

• 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.
• Strong oral, written and interpersonal communication and customer service skills.
• Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively.
• Strong organization and time management skills with the ability to manage workload independently.
• Ability to think critically and make decision within individual role and responsibility.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.

What You Will Do at Cambia:

• Performs essential case management activities—assessment, planning, implementation, coordination, monitoring, and evaluation to identify member needs, set goals, execute actions, organize resources, and measure effectiveness of outcomes.
• Applies clinical expertise and judgment using evidence-based criteria to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care, while practicing within license scope.
• Consults with physician advisors to ensure clinically appropriate determinations and serves as a resource to internal and external customers.
• Collaborates with other departments to resolve claims, quality of care, and member or provider issues.
• Identifies problems or needed changes, recommends resolutions, and participates in quality improvement efforts.
• Responds professionally in writing or by phone to members, providers, and regulatory organizations while protecting the confidentiality of sensitive documents and issues.
• Provides consistent, accurate documentation and plans, organizes, and prioritizes assignments to meet performance standards, corporate goals, and established timelines.

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.

• National pay structure — applies to Washington, Oregon, and to the Boise, Lewiston, and Salt Lake City metro areas: The full hourly range is $35.00 - $57.00 per hour, and the bonus target is 8%.
• Regional pay structure — applies to Arkansas, and to the Idaho, and Utah locations outside the metro areas listed above: The full salary range is $31.50 - $51.30 per hour and the bonus target is 8%.

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. As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.

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.

If you need accommodation for any part of the application process because of a medical condition or disability, please email . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.