Remote Care Management Nurse — Case & Disease Coordination

Cambia Health; Coeur d'Alene (ID); Remote; USD 51,000 - 69,000; Full time

Benefits offered by this job

401(k) match

Paid time off

Wellness programs

Job summary

Cambia Health is hiring a Remote Care Management Nurse to provide case management, disease management, and care coordination for members across Oregon, Washington, Idaho or Utah with a preference for Idaho/Utah residents. This role supports a person-focused healthcare experience and requires an active RN license and multi-state eligibility.

The position offers remote work opportunities and competitive compensation with benefits.

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
• 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, utilizing evidence-based criteria and practicing within the scope of their license.
• 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 and participating in quality improvement efforts.
• 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 management

Case management

Utilization management

Disease management

Care coordination

Strong communication

Time management

AI tools experience

Education

Associate's or Bachelor's in Nursing or health/human services

RN license (active/unrestricted)

Eligible for licensure in ID, OR, UT, WA

Tools

Microsoft Office

Outlook

Health care documentation systems

Job description

Cambia Health is hiring a Remote Care Management Nurse to provide case management, disease management, and care coordination for members across Oregon, Washington, Idaho or Utah with a preference for Idaho/Utah residents. This role supports a person-focused healthcare experience and requires an active RN license and multi-state eligibility.

The position offers remote work opportunities and competitive compensation with benefits.