Remote Utilization Management Nurse for Care Quality

Cambia Health Solutions, Inc.; Spokane (WA); Remote; USD 51.000 - 69.000; Vollzeit

Benefits dieser Stelle

Work from home options

Competitive benefits

Zusammenfassung

Cambia Health Solutions, Inc. is hiring a Utilization Management Nurse who will conduct reviews to ensure medical necessity and cost-effective outcomes.

Working from home within the states of Oregon, Washington, Idaho or Utah, you will assess patient needs and collaborate with care teams to promote quality care. The role requires nursing licensure, at least three years in case management, and the ability to interpret policies.

Qualifikationen

• Nurse licensure in at least one US state with ability to practice independently.
• At least 3 years in case management or utilization management.
• Willingness to obtain licensure in multiple states served by Cambia.
• Experience with prospective or retrospective reviews is a plus.
• Ability to interpret policies and communicate complex topics clearly.

Aufgaben

• Conduct utilization management reviews to ensure medical necessity and compliance with policy and standards of care.
• Apply clinical expertise and evidence-based criteria to make determinations and consult with physician advisors as needed.
• Collaborates with interdisciplinary teams to facilitate transitions of care.
• Serves as a resource to internal and external customers, providing accurate and timely responses to inquiries.
• Identifies opportunities for improvement and participates in quality improvement efforts.
• Maintains accurate and consistent documentation and prioritizes assignments to meet performance standards.

Kenntnisse

Healthcare policy understanding

Strong communication skills

Microsoft Office proficiency

Independent decision making

Time management

Ausbildung

Associate or Bachelor’s Degree in Nursing or related field

Jobbeschreibung

Cambia Health Solutions, Inc. is hiring a Utilization Management Nurse who will conduct reviews to ensure medical necessity and cost-effective outcomes.

Working from home within the states of Oregon, Washington, Idaho or Utah, you will assess patient needs and collaborate with care teams to promote quality care. The role requires nursing licensure, at least three years in case management, and the ability to interpret policies.