Remote Utilization Management Nurse: Improve Care & Costs

Cambia Health Solutions; Medford (OR); À distance; USD 51 412 000 - 69 431 000; Plein temps

Avantages offerts par ce poste

Health benefits

401(k) with match

Paid time off

Holidays

Wellness programs

Employee Assistance Fund

Parental leave

Commuter parking benefits

Résumé du poste

Cambia Health Solutions in Medford, OR is seeking an experienced Utilization Management Nurse to perform prospective, concurrent, and retrospective reviews ensuring medical necessity and adherence to policy. You will apply evidence-based criteria and collaborate with physician advisors to optimize member care and appropriate payments.

The role requires an Associate or Bachelor's in Nursing, an RN license, and at least 3 years in case management or utilization management, with licensure in states

Qualifications

• Associate or Bachelor's degree in Nursing or related field and RN license.
• At least 3 years in case management or utilization management.
• Current unrestricted RN license and state licensure in relevant states.

Responsabilités

• Conducts utilization management reviews to ensure medical necessity.
• Applies clinical criteria and consults with physician advisors as needed.
• Collaborates with interdisciplinary teams to facilitate care transitions.
• Provides timely responses to internal and external inquiries.
• Identifies opportunities for process improvement and quality initiatives.
• Maintains accurate documentation and protects patient confidentiality.

Connaissances

Healthcare knowledge

MS Office

Communication skills

Policy interpretation

Time management

Critical thinking

AI tools experience

Formation

Nursing degree

RN license

State licensure in US

Outils

Microsoft Office

Health record systems

Description du poste

Cambia Health Solutions in Medford, OR is seeking an experienced Utilization Management Nurse to perform prospective, concurrent, and retrospective reviews ensuring medical necessity and adherence to policy. You will apply evidence-based criteria and collaborate with physician advisors to optimize member care and appropriate payments.

The role requires an Associate or Bachelor's in Nursing, an RN license, and at least 3 years in case management or utilization management, with licensure in states