Remote Utilization Management Nurse — Elevate Care

Cambia Health Solutions; Washington; Remote; USD 80,000 - 105,000; Full time

Benefits offered by this job

Medical coverage

Dental & Vision

401(k) match

Paid time off

HSA contribution

Parental leave

Wellness programs

Employee assistance

Job summary

Cambia Health Solutions seeks an experienced Utilization Management Nurse to support member care across multiple states. The role performs prospective, concurrent and retrospective reviews to ensure medical necessity and optimal outcomes, coordinating with clinical teams to facilitate safe transitions of care.

RN licensed with 3 years of case/ utilization management experience is required; strong communication, organization, and policy interpretation skills are essential.

Qualifications

• Associate or Bachelor’s Degree in Nursing or related field.
• 3 years of case management, utilization management, disease management, auditing or retrospective review experience.
• Equivalent combination of education and experience.
• RN license (unrestricted) in US states served by Cambia (Idaho, Oregon, Utah, Washington).
• Bachelor’s degree in health or human services-related field or RN license as alternative qualification.

Responsibilities

• Conduct utilization management reviews (prospective, concurrent, retrospective).
• Apply clinical criteria and consult physicians as needed.
• Collaborate with interdisciplinary teams to facilitate transitions of care.

Skills

Nurse knowledge

Case management

Policy interpretation

Communication skills

Organizational skills

AI tools experience

Education

Associate or Bachelor’s Degree in Nursing or related field

RN license

Bachelor’s degree in health or human services field

Job description

Cambia Health Solutions seeks an experienced Utilization Management Nurse to support member care across multiple states. The role performs prospective, concurrent and retrospective reviews to ensure medical necessity and optimal outcomes, coordinating with clinical teams to facilitate safe transitions of care.

RN licensed with 3 years of case/ utilization management experience is required; strong communication, organization, and policy interpretation skills are essential.