Remote Utilization Management Nurse – Impactful Care

Cambia Health; Pocatello (ID); Remote; USD 48,000 - 79,000; Full time

Benefits offered by this job

Competitive base pay

Bonus target (8%)

Healthcare benefits

401(k) with company match

Paid time off and holidays

Job summary

Cambia is hiring an Utilization Management Nurse to support our Clinical Services team. This remote role covers multiple states (OR, WA, ID, UT) with preference for Idaho/Utah residents and current employees.

You will perform utilization reviews, apply clinical criteria, and work with interdisciplinary teams to ensure appropriate and cost-effective care. The position emphasizes independent decision making, documentation accuracy, and excellent communication as you support member health journeys

Qualifications

• Associate or Bachelor's Degree in Nursing or related field is required.
• 3 years of case management, utilization management, disease management, auditing or retrospective review experience.
• Must have licensure or certification in a US state/territory to practice independently.
• May need licensure in Idaho, Oregon, Utah and Washington.
• RN license (current unrestricted) for medical care management.

Responsibilities

• Conduct utilization management reviews (prospective, concurrent, retrospective) to determine medical necessity and compliance with policy.
• Apply clinical expertise and evidence-based criteria to make determinations and consult with physician advisors.
• Collaborate with interdisciplinary teams to facilitate transitions of care and resolve issues.
• Provide timely, accurate responses to inquiries and maintain documentation.

Skills

Case management experience

Clinical assessment

Documentation and record keeping

Communication skills

Time management

Education

Bachelor's Degree in Nursing

RN license

Tools

Microsoft Office

Healthcare documentation systems

Job description

Cambia is hiring an Utilization Management Nurse to support our Clinical Services team. This remote role covers multiple states (OR, WA, ID, UT) with preference for Idaho/Utah residents and current employees.

You will perform utilization reviews, apply clinical criteria, and work with interdisciplinary teams to ensure appropriate and cost-effective care. The position emphasizes independent decision making, documentation accuracy, and excellent communication as you support member health journeys