Remote Utilization Management Nurse | Impact Health

Cambia Health Solutions; Spokane (WA); Remote; USD 48,000 - 79,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Health savings account contribution

Paid time off and holidays

401(k) plan with company match

Parental leave and wellness programs

Employee Assistance Fund

Job summary

Cambia Health Solutions is seeking an experienced Utilization Management Nurse to support our Clinical Services team. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and appropriate care, while applying evidence-based criteria and consulting with physician advisors as needed.

The role emphasizes collaboration with care teams, strong documentation, and the use of AI tools to enhance decision-making in a fast-paced healthcare environment.

Qualifications

• Associate or Bachelor’s Degree in Nursing or related field.
• Must have licensure/certification in a U.S. state/territory and at least 3 years of direct clinical care.
• May require licensure in all four states Cambia serves (ID, OR, UT, WA).

Responsibilities

• Conducts utilization management reviews (prospective, concurrent, retrospective) to ensure medical necessity and policy adherence.
• Applies clinical judgment and criteria to determine determinations and consults with physician advisors.
• Collaborates with interdisciplinary teams to facilitate transitions of care and resolve issues.
• Serves as a resource to internal and external customers with accurate responses to inquiries.
• Identifies opportunities for improvement and participates in quality initiatives.
• Maintains accurate documentation and prioritizes assignments to meet performance standards.

Skills

Nursing knowledge

Case management

Utilization management

Communication skills

Independent decision-making

AI tools experience

Education

Associate or Bachelor’s in Nursing

RN license

Tools

Microsoft Office

EHR systems

Job description

Cambia Health Solutions is seeking an experienced Utilization Management Nurse to support our Clinical Services team. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and appropriate care, while applying evidence-based criteria and consulting with physician advisors as needed.

The role emphasizes collaboration with care teams, strong documentation, and the use of AI tools to enhance decision-making in a fast-paced healthcare environment.