Remote Care Management Clinician (RN)

Cambia Health Solutions; Austin (TX); Remote; USD 44,000 - 79,000; Full time

Job summary

Cambia Health Solutions is seeking a Care Management Clinician to provide case management, disease management, and care coordination, with work-from-home options across several western states. The role emphasizes independent decision making, clinical judgment, and adherence to medical policy within licensure scope.

Qualifications include nursing degree (Associate or BSN) with 3 years of relevant experience, active licensure, and URAC certification or related health degree or RN license.

Qualifications

• Associate or Bachelor's Degree in Nursing or related field with 3 years of case management, utilization management, disease management, or behavioral health case management experience.

Responsibilities

• Perform 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 standards 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.

Skills

Health insurance knowledge

Office & Outlook skills

Interpersonal communication

Decision making

Time management

AI tools experience

Education

Associate or Bachelor's Degree in Nursing

Tools

Microsoft Office

Outlook

Healthcare documentation systems

Job description

Cambia Health Solutions is seeking a Care Management Clinician to provide case management, disease management, and care coordination, with work-from-home options across several western states. The role emphasizes independent decision making, clinical judgment, and adherence to medical policy within licensure scope.

Qualifications include nursing degree (Associate or BSN) with 3 years of relevant experience, active licensure, and URAC certification or related health degree or RN license.