Remote Care Management Clinician

Cambia Health

Boise (ID)

Remote

USD 43,000 - 79,000

Full time

14 days+

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Benefits offered by this job

Work from home options

Competitive benefits

401(k) with company match

Job summary

Cambia Health is seeking a Care Management Clinician to work from home within Idaho, Oregon, Utah, and Washington. The role includes case management, disease management, and care coordination to meet member needs and improve outcomes.

Strong organization and communication are essential, with a focus on independent judgment within practice scope. Applicants should have nursing or related degrees and relevant licensure, with experience in direct clinical care.

Qualifications

Associate or Bachelor's Degree in Nursing or related field and 3+ years of case management or related experience.
Must have licensure or certification allowing independent assessment in a health or human services discipline and at least 3 years of direct clinical care.
One of URAC case manager certification, or a health-related Bachelor's/Master's, or RN license with scope for medical care management.

Responsibilities

Perform essential case management: assessment, planning, implementation, coordination, monitoring and evaluation.
Apply clinical criteria to ensure compliance with medical policy and medical necessity guidelines.
Consult with physician advisors to ensure determinations and serve as a resource to internal/external customers.
Collaborate with other departments to resolve claims and quality of care issues.
Identify problems, propose resolutions, and participate in quality improvement efforts.
Respond to members and providers professionally and protect confidentiality.
Provide consistent documentation and prioritize assignments to meet timelines.