Remote Utilization Management Nurse - Make an Impact

Cambia Health Solutions; Burlington (WA); Remote; USD 72,000 - 118,000; Full time

Benefits offered by this job

Health benefits

401(k) matching

Paid time off

Job summary

Cambia Health Solutions is hiring an Utilization Management Nurse to support prospective, concurrent, and retrospective reviews ensuring medical necessity and cost-effective care. You will apply clinical criteria and collaborate with physician advisors as needed.

Join a mission-driven team enabling patient-centered outcomes while working in a flexible, remote-capable role across several states. An RN license and nursing degree are required, with opportunities for professional growth in a

Qualifications

• 3 years of case management, utilization management, disease management, auditing or retrospective review experience.
• Must have licensure or certification in a health or human services discipline and 3+ years of direct clinical care.
• May need licensure in all four states served: ID, OR, UT, WA.

Responsibilities

• Conduct utilization management reviews (prospective, concurrent, retrospective) to ensure medical necessity.
• Apply clinical expertise and evidence-based criteria to make determinations.
• Collaborate with interdisciplinary teams to facilitate transitions of care.

Skills

Case management

Utilization management

Clinical assessment

Interpersonal communication

Time management

Education

Bachelor’s degree in Nursing or related field

RN license (unrestricted)

Tools

Microsoft Office

Job description

Cambia Health Solutions is hiring an Utilization Management Nurse to support prospective, concurrent, and retrospective reviews ensuring medical necessity and cost-effective care. You will apply clinical criteria and collaborate with physician advisors as needed.

Join a mission-driven team enabling patient-centered outcomes while working in a flexible, remote-capable role across several states. An RN license and nursing degree are required, with opportunities for professional growth in a