Remote Utilization Management Nurse | Care-Centric

Cambia Health Solutions, Inc.; Lewiston (ID); À distance; USD 47 000 - 62 000; Plein temps

Avantages offerts par ce poste

401(k) plan with company match

Bonus potential (target 8%)

Work-from-home options

Résumé du poste

Cambia Health Solutions, Inc. is seeking an experienced Utilization Management Nurse to join our Clinical Services team.

The role conducts prospective, concurrent, and retrospective reviews to ensure medical necessity and cost-effective care, collaborating with physicians and care teams. This remote opportunity supports Idaho, Oregon, Utah, Washington, or other eligible locations, with pay structures reflecting regional markets.

Qualifications

• Bachelor’s or Associate Degree in Nursing; RN license required.
• 3 years of case management, utilization management, disease management, auditing or retrospective review experience.
• Equivalent combination of education and experience acceptable.
• Must hold an unrestricted RN license and licensure in applicable states (ID, OR, UT, WA).

Responsabilités

• Conducts utilization management reviews (prospective, concurrent, retrospective) to ensure medical necessity and compliance.
• Applies clinical criteria and consults with physician advisors as needed.
• Collaborates with care teams to facilitate transitions and resolve issues.
• Provides timely, accurate responses to inquiries from members and providers.
• Maintains compliant documentation and supports quality improvement initiatives.
• Protects confidentiality of sensitive information and communicates professionally.

Connaissances

Case management

Utilization management

Interdisciplinary collaboration

Communication skills

Formation

Bachelor’s or Associate Degree in Nursing

RN license

Outils

EMR/EHR systems

Microsoft Office

Description du poste

Cambia Health Solutions, Inc. is seeking an experienced Utilization Management Nurse to join our Clinical Services team.

The role conducts prospective, concurrent, and retrospective reviews to ensure medical necessity and cost-effective care, collaborating with physicians and care teams. This remote opportunity supports Idaho, Oregon, Utah, Washington, or other eligible locations, with pay structures reflecting regional markets.