Remote Care Management RN - Impactful, Flexible Role

Cambia Health Solutions; Eagle (ID); À distance; USD 48 000 - 79 000; Plein temps

Avantages offerts par ce poste

401(k) match

Bonus opportunities

Health benefits

Paid time off

Résumé du poste

Cambia Health Solutions is seeking a Remote Care Management Nurse to transition from bedside care to a clinical management role. You will conduct assessments, plan care, coordinate services, and monitor outcomes for members across multiple states, leveraging your nursing expertise and knowledge of health insurance trends.

Qualifications include an RN license and a minimum of three years of direct clinical care or case management experience.

Qualifications

• RN license required for medical care management in applicable states
• Knowledge of health insurance industry trends, technology and contractual arrangements
• Strong oral, written and interpersonal communication and customer service skills
• General computer skills (Microsoft Office, Outlook, internet search)
• Familiarity with health care documentation systems
• Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively
• Strong organization and time management skills with the ability to manage workload independently
• Minimum 3 years of direct clinical care or experience in case management, utilization management, disease management, auditing, or retrospective review

Responsabilités

• 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
• 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
• Monitors and evaluates the effectiveness of case management plans, gathering sufficient information to determine the plan's effectiveness and making adjustments as needed
• Conducts case management activities to assess, plan, implement, coordinate, monitor, and evaluate care to meet member needs
• Utilizes evidence-based criteria and practices within the scope of nurse licensure

Connaissances

Clinical care experience

Case management

Care coordination

RN license

Communication skills

Time management

Interpersonal skills

Policy interpretation

Independent decision making

Customer service

Formation

Nursing or health/human services degree

Outils

Microsoft Office

Outlook

Description du poste

Cambia Health Solutions is seeking a Remote Care Management Nurse to transition from bedside care to a clinical management role. You will conduct assessments, plan care, coordinate services, and monitor outcomes for members across multiple states, leveraging your nursing expertise and knowledge of health insurance trends.

Qualifications include an RN license and a minimum of three years of direct clinical care or case management experience.