Remote Utilization Management Nurse | Case Management Expert

Cambia Health Solutions, Inc.; Salem (OR); Remoto; USD 48.000 - 79.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health insurance

401(k) with company match

Paid time off

Parental leave

Wellness programs

Employee Assistance Fund

Commuter benefits

Descrizione del lavoro

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

This role focuses on prospective, concurrent, and retrospective reviews to ensure medical necessity and cost-effective care across Oregon, Washington, Idaho, and Utah. The role emphasizes collaboration with interdisciplinary teams, application of evidence-based criteria, and thorough documentation to support transitions of care while protecting member confidentiality.

Competenze

• Associate or Bachelor's Degree in Nursing or related field.
• 3 years of case management, utilization management, disease management, auditing or retrospective review experience.
• Must have licensure/certification in a US state to conduct assessments.
• May need licensure in all four states Cambia serves: ID, OR, UT, WA.

Mansioni

• Conducts utilization management reviews (prospective, concurrent, retrospective).
• Applies clinical expertise and evidence-based criteria to make determinations.
• Collaborates with interdisciplinary teams to facilitate transitions of care.
• Provides timely responses to inquiries from members and providers.
• Identifies opportunities for quality improvement and contributes to initiatives.
• Maintains accurate documentation and prioritizes assignments to meet standards.

Conoscenze

Nursing

Case management

Utilization management

Clinical care

Licensure

Formazione

Associate or Bachelor's Degree in Nursing

Strumenti

Microsoft Office

Health care documentation systems

Descrizione del lavoro

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

This role focuses on prospective, concurrent, and retrospective reviews to ensure medical necessity and cost-effective care across Oregon, Washington, Idaho, and Utah. The role emphasizes collaboration with interdisciplinary teams, application of evidence-based criteria, and thorough documentation to support transitions of care while protecting member confidentiality.