Remote Oncology Care Manager RN

Cambia Health Solutions, Inc.; Coeur d'Alene (ID); Remote; USD 48,000 - 79,000; Full time

Benefits offered by this job

Healthcare benefits

401(k) plan

Paid time off

Parental leave

Wellness programs

Job summary

Cambia Health Solutions, Inc. is hiring a Care Management RN to join our Clinical Services team. This role focuses on case management, disease management, and care coordination to deliver person-centered, cost-effective care.

Work-from-home options are available, with preference for Idaho and Utah residents and alignment with national pay structures. Applicants must hold an RN license and meet licensure requirements across Idaho, Oregon, Utah, and Washington, with at least 3 years of direct

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 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

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

Clinical care management

Case management

Utilization management

Healthcare policy understanding

Education

Nursing/health degree

Job description

Cambia Health Solutions, Inc. is hiring a Care Management RN to join our Clinical Services team. This role focuses on case management, disease management, and care coordination to deliver person-centered, cost-effective care.

Work-from-home options are available, with preference for Idaho and Utah residents and alignment with national pay structures. Applicants must hold an RN license and meet licensure requirements across Idaho, Oregon, Utah, and Washington, with at least 3 years of direct