Remote Utilization Management Nurse

Cambia Health; Yakima (WA); Remote; USD 48,000 - 79,000; Full time

Benefits offered by this job

Remote-friendly work policy

Competitive compensation

401(k) with company match

Generous PTO and holidays

Job summary

Cambia Health is seeking an Utilization Management Nurse to support healthcare decisions remotely across Oregon, Washington, Idaho, or Utah. You will review medical necessity using prospective, concurrent, and retrospective approaches and collaborate with care teams to ensure quality and cost-effectiveness.

The role requires an RN license (multi-state may be needed), and a background in case management or related fields.

Qualifications

• Bachelor's or Associate degree in Nursing or related field.
• 3 years of case management, utilization management, disease management, auditing or retrospective review experience.
• RN license current and unrestricted; multi-state licensure may be required.

Responsibilities

• Perform utilization management reviews (prospective, concurrent, retrospective) to ensure medical necessity.
• Apply evidence-based criteria and consult with physician advisors as needed.
• Collaborate with interdisciplinary teams to facilitate transitions of care.
• Respond to inquiries with accurate information and professional communication.
• Identify opportunities for process and quality improvement initiatives.
• Maintain accurate documentation and manage workload to meet performance standards.
• Protect confidentiality of sensitive information and adhere to regulatory requirements.

Skills

Healthcare knowledge

Microsoft Office

Documentation systems

Communication

Policy interpretation

Time management

Critical thinking

Education

Associate/Bachelor's Nursing

RN license

Job description

Cambia Health is seeking an Utilization Management Nurse to support healthcare decisions remotely across Oregon, Washington, Idaho, or Utah. You will review medical necessity using prospective, concurrent, and retrospective approaches and collaborate with care teams to ensure quality and cost-effectiveness.

The role requires an RN license (multi-state may be needed), and a background in case management or related fields.