Remote RN Care Manager - Case & Disease Management

Cambia Health Solutions, Inc.; Lewiston (ID); Remote; USD 48,000 - 79,000; Full time

Benefits offered by this job

Health insurance

Paid time off

401(k) match

Parental leave

Wellness programs

Job summary

Cambia Health Solutions, Inc. is seeking a Care Management RN to provide clinical case management, disease management, and care coordination. The role supports member-focused care across states, with emphasis on quality and cost-effective outcomes.

The position offers remote work options with pay ranges tied to regional structures. The ideal candidate will have RN licensure, 3+ years of clinical care or case management experience, and eligibility for licensure in ID/OR/UT/WA, plus familiarity

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

Nursing degree

Clinical care experience

RN licensure

Licensure in ID/OR/UT/WA

Healthcare communication

AI experience (tools)

Education

Associate's or Bachelor's degree

Equivalent experience in lieu of a degree

Tools

Microsoft Office

Outlook

Electronic health records

Job description

Cambia Health Solutions, Inc. is seeking a Care Management RN to provide clinical case management, disease management, and care coordination. The role supports member-focused care across states, with emphasis on quality and cost-effective outcomes.

The position offers remote work options with pay ranges tied to regional structures. The ideal candidate will have RN licensure, 3+ years of clinical care or case management experience, and eligibility for licensure in ID/OR/UT/WA, plus familiarity