Health Care & Nursing

Cambia Health Solutions; Provo (UT); Remote; USD 48,000 - 79,000; Full time

Benefits offered by this job

401(k) with company match

Bonus opportunities

Paid time off

Holidays

Job summary

Cambia Health Solutions is seeking an experienced Remote Care Management Nurse to support patients from home across multiple states, including OR, WA, ID and UT. The role focuses on care management, disease and utilization management with an emphasis on cost-effective, high-quality care.

Responsibilities include assessing, planning, coordinating, monitoring, and evaluating care; collaborating with physicians and teams; and ensuring documentation and policy alignment.

Qualifications

• Nursing or health/human services degree (Associate's or Bachelor's minimum) or equivalent experience.
• Minimum 3 years of direct clinical care or experience in case management, utilization management, disease management, auditing, or retrospective review.
• S. state or territory allows independent assessments; RN license required for medical care management.
• Knowledge of health insurance industry trends, technology and contractual arrangements.
• General computer skills (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.

Responsibilities

• 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, utilizing evidence-based criteria.
• Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes.
• Serves as a resource to internal and external customers, responding to inquiries professionally while protecting confidentiality.
• Provides consistent and accurate documentation, ensuring compliance with performance standards, corporate goals, and established timelines.
• Monitors and evaluates the effectiveness of case management plans, gathering information to determine effectiveness and adjust as needed.

Skills

Clinical care

RN license

Case management

Utilization management

Disease management

Auditing

Documentation systems

Communication skills

Microsoft Office

Education

Registered Nurse (RN) license

Job description

Remote Care Management Nurse (Future Opportunities)

Work from home within Oregon, Washington, Idaho or Utah

Join our Cause to create a person-focused and economically sustainable health care system.

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 (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. Oversees a collaborative process with the member and those involved in the member’s care to assess, plan, implement, coordinate, monitor and evaluate care as needed - all in service of creating a person-focused health care experience.

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? Nursing or health/human services degree (Associate's or Bachelor's minimum), or equivalent experience in lieu of a degree

• Minimum 3 years of direct clinical care or experience in case management, utilization management, disease management, auditing, or retrospective review
• S. state or territory that allows you to independently conduct assessments within your scope of practice — RN license required for medical care management
• 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.

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, utilizing evidence-based criteria and practicing within the scope of their license.

Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions and participating in quality improvement efforts.

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.

Monitors and evaluates the effectiveness of case management plans, gathering sufficient information to determine the plan's effectiveness and making adjustments as needed.

#LI-Remote

The expected hiring range depends on skills, experience, education, and training; and performance history.

National pay structure — applies to the Boise, Portland, Salem, Seattle/Renton/Tacoma, Burlington, Vancouver, and Salt Lake City metro areas. The full salary range is $35.00 - $57.00 and the bonus target is 8%. Regional pay structure — applies to North Dakota and to Idaho, Oregon, Washington, and Utah locations outside the metro areas listed above. The full salary range is $31.50 - $51.30 and the bonus target is 8%. 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.

Work alongside diverse teams building cutting-edge solutions to transform health care.

Grow your career with a company committed to helping you succeed.

Give back to your community by participating in Cambia-supported outreach programs.

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. 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).

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. 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. If you need accommodation for any part of the application process because of a medical condition or disability, please email

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