Care Management Nurse (Future Opportunities)

Cambia Health Solutions; Myrtle Point (OR); Remote; USD 80,000 - 100,000; Full time

Job summary

A reputable health solutions company seeks Care Management Nurses for future opportunities. This role involves conducting case management activities and ensuring compliance with medical standards. Candidates should possess a nursing degree and have at least three years of relevant experience. This position offers the flexibility of working from home within the Pacific Northwest.

Benefits

Competitive salary

Generous benefits

Career growth opportunities

Qualifications

• At least 3 years of experience in case management or related field.
• Must have relevant licensure or certification for assessment.
• Experience in direct clinical care.

Responsibilities

• Conduct case management activities to meet member needs.
• Ensure compliance with medical policies and standards of care.
• Collaborate with other professionals to resolve issues.

Skills

Knowledge of health insurance industry trends

Strong communication skills

Time management skills

Ability to make decisions

Education

Associate or Bachelor’s Degree in Nursing

Job description

Care Management Nurse (Future Opportunities)

Work from home within Oregon, Washington, Idaho or Utah

Please be advised that this role is part of our candidate pool, which allows us to identify and attract exceptional talent for future opportunities. Although we may not have immediate openings, we invite you to submit your resume for consideration.

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 RN's are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Care Management RN's provide clinical care management to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes.

Are you a Registered Nurse looking to transition out of bedside care and into a role that still utilizes your clinical expertise, but offers a fresh challenge? Is your goal to promote quality, cost-effective outcomes and improve overall health and wellbeing? Then this role may be the perfect fit.

What You Bring to Cambia:

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, 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 and at least 3 years 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 in a health or human services-related field; or Registered nurse (RN) license.

Skills and Attributes:

• Knowledge of health insurance industry trends, technology and contractual arrangements.
• General computer skills and 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.

What You Will Do at Cambia:

• Conducts case management activities, including assessment, planning, implementation, coordination, monitoring, and evaluation to identify and meet member needs.
• Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care.
• Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues.
• Serves as a resource to internal and external customers, responding to inquiries in a professional manner while protecting confidentiality of sensitive documents and issues.
• Provides consistent and accurate documentation, ensuring compliance with performance standards, corporate goals, and established timelines.
• Coordinates resources, organizes, and prioritizes assignments to meet goals and timelines.
• Monitors and evaluates the effectiveness of case management plans, gathering sufficient information to determine the plan's effectiveness and making adjustments as needed.

The expected hiring range for a Utilization Management Nurse is $38.00 - $41.50 an hour depending on skills, experience, education, and training.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation.

Why Join the Cambia Team?

• 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 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.