Remote Care Management Nurse - Case & Care Coordination

Cambia Health; Medford (OR); Remote; USD 43,000 - 71,000; Full time

Benefits offered by this job

401(k) with company match

Health, dental and vision coverage

Paid time off and holidays

Wellness programs

Job summary

Cambia Health is seeking a Remote Care Management Nurse to provide clinical care management, including case management and care coordination, from home within eligible western states. The role involves collaborating with physicians and care teams to ensure medical policy adherence and to deliver person-focused care, with licensure in applicable states and a strong emphasis on patient outcomes.

Ideal candidates hold an RN license (or equivalent) with at least 3 years of direct clinical or care

Qualifications

• Nursing or health/human services degree (Associate's or Bachelor's minimum) or equivalent experience
• Minimum 3 years of direct clinical care or experience in case management, utilization management, disease management, auditing, or retrospective review
• Active, unrestricted licensure or certification in a U.S. state or territory that allows you to independently conduct assessments within your scope of practice - RN license required for medical care management
• Must be eligible for licensure in Idaho, Oregon, Utah, and Washington

Responsibilities

• Conducts case management activities, including assessment, planning, implementation, coordination, monitoring, and evaluation to identify and meet member needs
• Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care
• Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues
• Serves as a resource to internal and external customers, responding to inquiries in a professional manner while protecting confidentiality of sensitive documents and issues
• Provides consistent and accurate documentation, ensuring compliance with performance standards, corporate goals, and established timelines
• Coordinates resources, organizes, and prioritizes assignments to meet goals and timelines
• Monitors and evaluates the effectiveness of case management plans, gathering sufficient information to determine the plan's effectiveness and making adjustments as needed

Skills

Healthcare knowledge

Computer skills

Communication

Time management

Critical thinking

AI tools

Interpersonal skills

Education

Nursing degree

Health/human services degree

Tools

Microsoft Office

Outlook

Health records systems

Job description

Cambia Health is seeking a Remote Care Management Nurse to provide clinical care management, including case management and care coordination, from home within eligible western states. The role involves collaborating with physicians and care teams to ensure medical policy adherence and to deliver person-focused care, with licensure in applicable states and a strong emphasis on patient outcomes.

Ideal candidates hold an RN license (or equivalent) with at least 3 years of direct clinical or care