Remote Care Management RN — Health Plan

Cambia Health Solutions, Inc.; Bellevue (WA); Remote; USD 51,000 - 69,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off and 10 holidays

401(k) retirement plan with company on

Parental leave up to 12 weeks

Wellness programs

Employee Assistance Fund

Commute and parking benefits

Job summary

Cambia Health Solutions, Inc. is seeking a Care Management RN to provide case management, disease management, and care coordination for members. The role supports a person-focused healthcare experience and involves working with an interdisciplinary team across various states.

The position offers work-from-home options and requires active RN licensure with eligibility in Idaho, Oregon, Utah, and Washington. Candidates with clinical care background and familiarity with AI tools are valued.

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 RN licensure in a U.S. state or territory
• Eligible for licensure in Idaho, Oregon, Utah, and Washington

Responsibilities

• Conducts case management activities from assessment to evaluation to meet member needs.
• Applies clinical judgment to ensure compliance with medical policy and guidelines.
• Collaborates with physicians, internal and external stakeholders to resolve claims and care issues.
• Serves as a resource to customers while protecting confidentiality of sensitive documents.
• Provides accurate documentation and adheres to performance standards and timelines.
• Coordinates resources and prioritizes assignments to meet goals and timelines.
• Monitors and evaluates the effectiveness of case management plans and adjusts as needed

Skills

Communication skills

Microsoft Office

Documentation systems

Organizational skills

Critical thinking

AI tools familiarity

Education

Nursing degree (Associate or Bachelor)

Job description

Cambia Health Solutions, Inc. is seeking a Care Management RN to provide case management, disease management, and care coordination for members. The role supports a person-focused healthcare experience and involves working with an interdisciplinary team across various states.

The position offers work-from-home options and requires active RN licensure with eligibility in Idaho, Oregon, Utah, and Washington. Candidates with clinical care background and familiarity with AI tools are valued.