Remote Care Management RN - Impactful Patient Care

Cambia Health; Boise (ID); Remote; USD 43,000 - 71,000; Full time

Benefits offered by this job

Health benefits

401(k) with company match

Paid time off

Job summary

Cambia Health is seeking a Remote Care Management Nurse to support members across multiple western states. The role focuses on case management, disease management, and care coordination within a collaborative Clinical Services team.

Ideal candidates hold a nursing or health services degree with 3+ years of direct clinical care, possess an active RN license, and are eligible for licensure in Idaho, Oregon, Utah, and Washington.

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 case management, utilization management, disease management, auditing, or retrospective review.
• Active, unrestricted RN license or equivalent to independently conduct assessments; RN license required for medical care management.
• Eligibility for licensure in Idaho, Oregon, Utah, and Washington.

Responsibilities

• Conducts case management activities: assessment, planning, implementation, coordination, monitoring, and evaluation to meet member needs.
• Applies clinical expertise to ensure compliance with medical policy, medical necessity guidelines, and standards of care within license scope.
• Collaborates with physician advisors and other departments to resolve claims and quality of care issues, identifying needed changes.
• Serves as a resource to internal/external customers, responding professionally while protecting confidentiality.
• Provides consistent, accurate documentation meeting performance standards and timelines.
• Coordinates resources, organizes and prioritizes assignments to meet goals.
• Monitors and evaluates effectiveness of case management plans and adjusts as needed.

Skills

Nursing/healthcare background

Case management

Communication skills

AI tools experience

Education

Nursing or health/human services degree

Tools

Microsoft Office

EHR systems

Job description

Cambia Health is seeking a Remote Care Management Nurse to support members across multiple western states. The role focuses on case management, disease management, and care coordination within a collaborative Clinical Services team.

Ideal candidates hold a nursing or health services degree with 3+ years of direct clinical care, possess an active RN license, and are eligible for licensure in Idaho, Oregon, Utah, and Washington.