Remote Care Management RN – Case & Coordination

Cambia Health; Portland (OR); Remote; USD 51,000 - 69,000; Full time

Job summary

Cambia Health is seeking a Remote Care Management Nurse to support members from home within Oregon, Washington, Idaho or Utah. You will perform case management, disease management and care coordination to promote quality and cost-effective outcomes.

You must hold an RN license (or nursing degree) and have 3+ years of clinical or case-management experience; eligibility for licensure in Idaho, Oregon, Utah and Washington is required.

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

RN License

Care coordination

Case management

Communication skills

Education

Nursing degree (Associate or Bachelor's)

Job description

Cambia Health is seeking a Remote Care Management Nurse to support members from home within Oregon, Washington, Idaho or Utah. You will perform case management, disease management and care coordination to promote quality and cost-effective outcomes.

You must hold an RN license (or nursing degree) and have 3+ years of clinical or case-management experience; eligibility for licensure in Idaho, Oregon, Utah and Washington is required.