Remote Utilization Management Nurse - Impactful Care

Cambia Health Solutions; Tacoma (WA); Hybrid; USD 75,000 - 110,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) match

Paid time off

Parental leave

Job summary

Cambia Health Solutions seeks an experienced Utilization Management Nurse to ensure medical necessity and cost-effective outcomes for members. You will review cases prospectively, concurrently, and retrospectively, applying evidence-based criteria and consulting with physician advisors as needed.

Join a collaborative team focused on transitions of care, member advocacy and timely responses to inquiries. A current RN license and state licensure in applicable states are required.

Qualifications

• Associate or Bachelor’s Degree in Nursing required.
• 3+ years in case management, utilization management, disease management, auditing or retrospective review.
• Must have current RN license in the US with active status.
• Licensure in Idaho, Oregon, Utah, Washington may be required.

Responsibilities

• Conduct utilization management reviews (prospective, concurrent, retrospective).
• Apply clinical criteria to determine medical necessity and advise physicians.
• Collaborate with interdisciplinary teams to facilitate transitions of care.
• Provide timely, accurate responses to inquiries from members and providers.
• Support quality improvement initiatives and maintain documentation.
• Protect confidentiality in handling sensitive information.

Skills

Case management

Utilization management

Nursing

RN licensure

Healthcare documentation

AI tools

Education

Associate or Bachelor’s Degree in Nursing

Tools

Microsoft Office

Job description

Cambia Health Solutions seeks an experienced Utilization Management Nurse to ensure medical necessity and cost-effective outcomes for members. You will review cases prospectively, concurrently, and retrospectively, applying evidence-based criteria and consulting with physician advisors as needed.

Join a collaborative team focused on transitions of care, member advocacy and timely responses to inquiries. A current RN license and state licensure in applicable states are required.