Remote Utilization Management Nurse

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401(k) match

Paid time off

Parental leave

Job summary

Cambia Health is hiring an Utilization Management Nurse to support care decisions remotely in OR/WA/ID/UT with opportunities for Idaho or Utah residents. The role emphasizes clinical review, evidence-based criteria, and collaboration with care teams.

The position requires an active nursing license and 3+ years in case management or utilization management, with strong communication and organizational skills to manage workload and ensure compliant, efficient care delivery.

Qualifications

• Nursing degree and active licensure in the US, with up-to-date clinical credentials.
• Minimum three years in case management, utilization or retrospective review.
• Ability to interpret policies and apply evidence-based criteria.

Responsibilities

• Conduct utilization management reviews (prospective, concurrent, retrospective).
• Apply clinical expertise to determine medical necessity and consult as needed.
• Collaborate with interdisciplinary teams to facilitate transitions of care.
• Provide timely, accurate responses to inquiries and maintain documentation.

Skills

Communication skills

Interpersonal skills

Time management

Decision making

Critical thinking

Education

Associate or Bachelor's Degree in Nursing or related field

RN license (unrestricted) or equivalent

Licensure in Idaho/Oregon/Utah/Washington (preferred)

Tools

Microsoft Office

Outlook

Health care documentation systems

Job description

Cambia Health is hiring an Utilization Management Nurse to support care decisions remotely in OR/WA/ID/UT with opportunities for Idaho or Utah residents. The role emphasizes clinical review, evidence-based criteria, and collaboration with care teams.

The position requires an active nursing license and 3+ years in case management or utilization management, with strong communication and organizational skills to manage workload and ensure compliant, efficient care delivery.