Remote Care Management Clinician — RN/Behavioral Health

Cambia Health Solutions, Inc.; Provo (UT); A distancia; USD 43.000 - 71.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

Dental coverage

Vision coverage

401(k) with company match

Paid time off

Descripción de la vacante

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.

Formación

• 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.

Responsabilidades

• 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.

Conocimientos

Case management

Utilization management

Disease management

Behavioral health care management

Communication skills

Time management

Independent work

Policy interpretation

Educación

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)

Herramientas

Microsoft Office

Outlook

Health care documentation systems

Descripción del empleo

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.