Remote Care Management Nurse: Case & Care Coordination

Cambia Health; Renton (WA); Remote; USD 48,000 - 79,000; Full time

Benefits offered by this job

Medical coverage

Dental & vision

401(k) match

Paid time off & holidays

Parental leave

Wellness programs

Employee assistance

Job summary

Cambia Health is hiring Remote Care Management Nurses to deliver case management, disease management, and care coordination from home across eligible Western states. You’ll assess, plan, implement, coordinate, monitor and evaluate care for members, using evidence-based criteria and your clinical expertise.

Applicants should hold a nursing degree, be eligible for licensure in multiple states, and have 3+ years of direct clinical or care-management experience.

Qualifications

• Nursing or health/human services degree (Associate's or Bachelor's minimum), or equivalent experience in lieu of a degree
• 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

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, and identifies problems or needed changes, recommending resolutions
• 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

Clinical care

Case management

Communication

Decision making

Time management

Critical thinking

AI tools experience

Education

Nursing degree (Associate's or Bachelor's minimum)

RN license (eligible in targeted states)

Job description

Cambia Health is hiring Remote Care Management Nurses to deliver case management, disease management, and care coordination from home across eligible Western states. You’ll assess, plan, implement, coordinate, monitor and evaluate care for members, using evidence-based criteria and your clinical expertise.

Applicants should hold a nursing degree, be eligible for licensure in multiple states, and have 3+ years of direct clinical or care-management experience.