Remote Care Management RN — Impactful Flexible Role

Cambia Health Solutions; Lewiston (ID); In loco; USD 51.000 - 69.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental and vision coverage

Generous paid time off

Descrizione del lavoro

Cambia Health Solutions is seeking a Remote Care Management Nurse to support care coordination and case management from home within the Northwest region. The role emphasizes clinical judgment, evidence-based practice, and collaboration with physician advisors to optimize member outcomes.

Qualified candidates will have an RN license, 3+ years of direct clinical care or case management, and eligibility for licensure in ID, OR, UT, and WA.

Competenze

• Nursing or health/human services degree (Associate's or Bachelor's minimum).
• 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.

Mansioni

• 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.
• 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.

Conoscenze

Healthcare knowledge

MS Office

Communication skills

Policy interpretation

Time management

Critical thinking

AI tools experience

Formazione

Nursing or health/human services degree

Strumenti

Documentation systems

Descrizione del lavoro

Cambia Health Solutions is seeking a Remote Care Management Nurse to support care coordination and case management from home within the Northwest region. The role emphasizes clinical judgment, evidence-based practice, and collaboration with physician advisors to optimize member outcomes.

Qualified candidates will have an RN license, 3+ years of direct clinical care or case management, and eligibility for licensure in ID, OR, UT, and WA.