Remote Utilization Management Nurse: Improve Care & Costs

Cambia Health; Lewiston (ID); Remote; USD 46,000 - 62,000; Full time

Benefits offered by this job

Health benefits

401(k) plan

Paid time off

Job summary

Cambia Health is seeking an Utilization Management Nurse to perform prospective, concurrent, and retrospective reviews from a remote location across OR, WA, ID, or UT. The role emphasizes clinical judgment, compliance, and collaborative care delivery.

The ideal candidate holds an RN license with at least 3 years in case or utilization management and can navigate health documentation systems and MS Office. Idaho/Utah residents are encouraged to apply for optimal alignment.

Qualifications

• Nursing degree or related field required.
• 3 years of case/utilization management or similar experience.
• Active RN license or equivalent certification in US.
• Licensure in Idaho/Oregon/Utah/Washington preferred.
• State licensure to practice independently where applicable.

Responsibilities

• Perform prospective, concurrent, and retrospective utilization management.
• Apply evidence-based criteria to determine medical necessity.
• Collaborate with interdisciplinary teams to coordinate care.
• Provide timely, accurate responses to inquiries from members and providers.
• Maintain compliant documentation and case records.
• Support quality improvement initiatives.

Skills

Communication

Critical thinking

Time management

Interpersonal skills

IT literacy

Education

RN license or nursing degree

Tools

Microsoft Office

Outlook

Health documentation systems

Job description

Cambia Health is seeking an Utilization Management Nurse to perform prospective, concurrent, and retrospective reviews from a remote location across OR, WA, ID, or UT. The role emphasizes clinical judgment, compliance, and collaborative care delivery.

The ideal candidate holds an RN license with at least 3 years in case or utilization management and can navigate health documentation systems and MS Office. Idaho/Utah residents are encouraged to apply for optimal alignment.