Remote Care Management Clinician — Health Navigator

Cambia Health Solutions; Utah; Remote; USD 43,000 - 71,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

12 weeks parental leave

401(k) with company match

Job summary

Cambia Health Solutions is seeking a Care Management Clinician to deliver case management, care coordination, and disease management services remotely within Idaho, Oregon, Utah, and Washington. The role emphasizes clinical expertise, policy knowledge, and strong communication to improve member outcomes.

Ideal candidates hold an Associate or Bachelor’s in Nursing or related field with at least 3 years of direct clinical care.

Qualifications

• Requires Associate or Bachelor’s in Nursing or related field with 3 years of case management or related experience.
• Must hold licensure/certification allowing independent assessment in a health or human services discipline with 3+ years of direct clinical care.
• One of URAC case manager certification, health-related degree, or RN license with active, unrestricted status.

Responsibilities

• Perform essential case management activities across assessment, planning, implementation, coordination, monitoring and evaluation.
• Apply clinical judgment to ensure compliance with medical policy and standards of care within license scope.
• Consult with physician advisors to ensure appropriate determinations and act as a resource for internal/external customers.
• Collaborate with departments to resolve claims, quality of care, and member/provider issues.
• Identify problems, propose solutions, and participate in quality improvement efforts.
• Respond professionally to members, providers, and regulatory bodies while protecting confidentiality.
• Provide accurate documentation and prioritize assignments to meet timelines.

Skills

Insurance knowledge

Computer skills

Communication skills

Policy interpretation

Time management

Critical thinking

AI tools experience

Education

Associates or Bachelor’s in Nursing or related field

Tools

Microsoft Office

Outlook

EMR systems

Job description

Cambia Health Solutions is seeking a Care Management Clinician to deliver case management, care coordination, and disease management services remotely within Idaho, Oregon, Utah, and Washington. The role emphasizes clinical expertise, policy knowledge, and strong communication to improve member outcomes.

Ideal candidates hold an Associate or Bachelor’s in Nursing or related field with at least 3 years of direct clinical care.