Remote Utilization Management Nurse - Impactful Care

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

Benefits offered by this job

Work from home options

Health, dental & vision coverage

Health savings account contributions

Paid time off + holidays

401(k) retirement plan with company 1:

Parental leave up to 12 weeks

Job summary

Cambia Health is seeking an Utilization Management Nurse to support prospective, concurrent and retrospective reviews. This remote role requires an RN license and 3+ years in relevant fields, with openings across Oregon, Washington, Idaho, and Utah.

You will collaborate with interdisciplinary teams, ensure medical necessity, and contribute to cost-effective outcomes for members. A strong communication skill set and knowledge of health insurance trends are essential.

Qualifications

• Must have (RN) license in an unrestricted state.
• 3+ years in case management, utilization management, disease management, auditing or retrospective review.
• Bachelor’s degree or higher in health-related field or equivalent RN licensure.

Responsibilities

• Perform prospective, concurrent and retrospective utilization management reviews.
• Apply evidence-based criteria and consult physician advisors as needed.
• Collaborate with interdisciplinary teams to facilitate transitions of care.

Skills

RN license

Communication skills

Clinical decision making

Health insurance knowledge

Time management

Interdisciplinary collaboration

Education

Associate or Bachelor’s Degree in Nursing

Licensure in US health discipline

Tools

Microsoft Office

Outlook

Job description

Cambia Health is seeking an Utilization Management Nurse to support prospective, concurrent and retrospective reviews. This remote role requires an RN license and 3+ years in relevant fields, with openings across Oregon, Washington, Idaho, and Utah.

You will collaborate with interdisciplinary teams, ensure medical necessity, and contribute to cost-effective outcomes for members. A strong communication skill set and knowledge of health insurance trends are essential.