Remote Utilization Management Nurse: Drive Better Care

Cambia Health Solutions, Inc.

United States

Hybrid

USD 51,000 - 69,000

Full time

3 days ago

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Benefits offered by this job

Work from home options

Medical, dental and vision coverage

Competitive retirement plan & 401(k)

Job summary

Cambia Health Solutions, Inc. is seeking an Utilization Management Nurse to support prospective, concurrent, and retrospective reviews from a home-based role across Oregon, Washington, Idaho, and Utah.

The job emphasizes independent clinical assessment and collaboration with care teams to ensure medically necessary, cost-effective care. The ideal candidate holds a nursing degree with an active RN license and at least three years in utilization management or related fields, with flexibility for

Qualifications

Nursing degree or related field with active license in US
3 years of case management or utilization management or related experience
Ability to conduct assessments independently within scope of practice (medical/behavioral health)
May require licensure in all four Cambia states: ID, OR, UT, WA

Responsibilities

Conducts utilization management reviews (prospective, concurrent, retrospective) to ensure medical necessity and policy compliance
Applies clinical expertise and evidence-based criteria to make determinations; consults with physician advisors as needed
Collaborates with interdisciplinary teams to facilitate transitions of care and resolve issues
Provides timely responses to inquiries and maintains accurate documentation