Remote Utilization Management Nurse

Cambia Health; Bellevue (WA); Remote; USD 45,000 - 69,000; Full time

Job summary

Cambia Health is seeking an Utilization Management Nurse who can work remotely within the U.S. states of Oregon, Washington, Idaho or Utah. The role focuses on prospective, concurrent and retrospective reviews to ensure medical necessity and cost-effective care.

The candidate will bring 3+ years of case/ utilization management experience, an RN license (or equivalent), and a health/human services degree. Licensure in multiple states may be required.

Qualifications

• Bachelor’s or higher degree in nursing or related field; RN license required.
• 3 years of case management, utilization management, disease management, auditing or retrospective review experience.
• Licensure in a state or territory that allows independent assessment and at least 3 years of direct clinical care.
• May need licensure in all four states Cambia serves: ID, OR, UT, WA.

Responsibilities

• Conduct utilization management reviews (prospective, concurrent, retrospective) to determine medical necessity.
• Apply clinical criteria and consult physician advisors as needed.
• Collaborate with interdisciplinary teams to facilitate transitions of care.
• Provide timely, accurate responses to inquiries and support internal/external customers.
• Identify opportunities for quality improvement and maintain documentation.

Skills

Health insurance trends

Computer skills

Interpersonal communication

Time management

Independent work

Education

Associate or Bachelor's Degree in Nursing or related field

RN license or equivalent

Tools

Microsoft Office

Health care documentation systems

Job description

Cambia Health is seeking an Utilization Management Nurse who can work remotely within the U.S. states of Oregon, Washington, Idaho or Utah. The role focuses on prospective, concurrent and retrospective reviews to ensure medical necessity and cost-effective care.

The candidate will bring 3+ years of case/ utilization management experience, an RN license (or equivalent), and a health/human services degree. Licensure in multiple states may be required.