Medical Equipment Clinician

Cambia Health Solutions, Inc.; Provo (UT); Remote; USD 43,000 - 71,000; Full time

Benefits offered by this job

Health insurance

Dental coverage

Vision coverage

401(k) with company match

Paid time off

Job summary

Cambia Health Solutions, Inc. is seeking a Care Management Clinician to deliver clinical care management, case management, and care coordination for members across Idaho, Oregon, Utah, and Washington.

The role emphasizes organized, independent work and strong communication with providers and members. Qualified candidates typically hold an Associate or Bachelor's Degree in Nursing or related field, with 3 years of relevant experience and an active RN license or equivalent licensure.

Qualifications

• 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 health or human services discipline that allows independent assessment, plus at least 3 years of direct clinical care.
• Knowledge of health insurance industry trends, technology and contractual arrangements.
• General computer skills (Microsoft Office, Outlook) 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.
• Performs essential case management activities—assessment, planning, implementation, coordination, monitoring, and evaluation.
• Applies clinical expertise and judgment using evidence-based criteria to ensure compliance with medical policy and accepted standard of care.
• Consults with physician advisors to ensure clinically appropriate determinations.
• 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 confidentiality.
• Provides consistent, accurate documentation and plans, organizes, and prioritizes assignments to meet performance standards.

Responsibilities

• Provide clinical care management including case management, disease management and/or care coordination to meet member healthcare needs and promote quality outcomes.
• Perform assessment, planning, implementation, coordination, monitoring, and evaluation of member care.
• Interpret policies and procedures and communicate complex topics to members and providers.

Skills

Case management

Utilization management

Disease management

Behavioral health care management

Communication skills

Time management

Independent work

Policy interpretation

Education

Associate or Bachelor's Degree in Nursing or related field

RN license (current unrestricted)

Bachelor's or Master's in health/human services (Master's preferred for behavioral health)

Tools

Microsoft Office

Outlook

Health care documentation systems

Job description

Care Management Clinician

Work from home within Idaho, Oregon, Utah, and Washington. Join our Cause to create a person-focused and economically sustainable health care system.

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? 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
• 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)
• 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.
• 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 standard 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.

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

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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