Remote Utilization Management Nurse — Impact Care

Cambia Health; Salt Lake City (UT); Remote; USD 48,000 - 79,000; Full time

Benefits offered by this job

Remote work options

Commuting and parking benefits

Job summary

Cambia Health is seeking an Utilization Management Nurse to support members remotely across OR, WA, ID and UT. You will perform prospective, concurrent, and retrospective reviews, applying evidence-based criteria and collaborating with physician advisors.

You will work with interdisciplinary teams to ensure medical necessity, timely responses, and compliant care. A current RN license and relevant experience are required.

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.
• Must have licensure in a state or territory of the United States for independent assessment.
• May need licensure in Idaho, Oregon, Utah, Washington.
• Bachelor's or higher degree in health or human services-related field or RN license with current unrestricted license.

Responsibilities

• Conducts utilization management reviews (prospective, concurrent, retrospective) to ensure medical necessity and compliance with policy and standards of care.
• Applies clinical expertise and evidence-based criteria to make determinations and consults with physician advisors as needed.
• Collaborates with interdisciplinary teams, case management, and other departments to facilitate transitions of care and resolve issues.
• 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 and corporate goals.

Skills

Utilization management

Nursing license

Communication

Time management

Documentation

Education

RN license

Nursing degree

Tools

Microsoft Office

Job description

Cambia Health is seeking an Utilization Management Nurse to support members remotely across OR, WA, ID and UT. You will perform prospective, concurrent, and retrospective reviews, applying evidence-based criteria and collaborating with physician advisors.

You will work with interdisciplinary teams to ensure medical necessity, timely responses, and compliant care. A current RN license and relevant experience are required.