Remote Care Management RN — Transform Healthcare

Cambia Health Solutions, Inc.; Oregon; Remote; USD 51,000 - 69,000; Full time

Benefits offered by this job

Remote work options

Job summary

Cambia Health Solutions, Inc. is seeking a Care Management RN to perform case management, care coordination, and evidence-based reviews for members across Oregon, Washington, Idaho and Utah.

You will work from home in a role that emphasizes quality and cost-effective outcomes in a person-focused care model. The ideal candidate holds an RN license with 3+ years of clinical care or case management experience, and is eligible for licensure in the target states.

Qualifications

• RN license required for medical care management.
• 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.
• 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

Case Management

Communication

AI Tools Knowledge

Licensure eligibility Idaho OregonUtah

Education

Nursing or health/human services degree

Tools

Microsoft Office

Job description

Cambia Health Solutions, Inc. is seeking a Care Management RN to perform case management, care coordination, and evidence-based reviews for members across Oregon, Washington, Idaho and Utah.

You will work from home in a role that emphasizes quality and cost-effective outcomes in a person-focused care model. The ideal candidate holds an RN license with 3+ years of clinical care or case management experience, and is eligible for licensure in the target states.