Remote Utilization Management Nurse — Make Healthcare More Efficient

Cambia Health Solutions; Lewiston (ID); Remote; USD 105,447,000 - 159,603,000; Full time

Benefits offered by this job

Remote work option

Job summary

Cambia Health Solutions is seeking a dedicated Utilization Management Nurse to support members from home in the US, with preference for Idaho and Utah residents. You will conduct prospective, concurrent, and retrospective reviews to promote quality, cost-effective outcomes, and appropriate payments for services.

Qualified candidates have a nursing degree, 3+ years in case/utilization management, and RN licensure.

Qualifications

• Associate or Bachelor’s Degree in Nursing or related field and 3 years in case management or utilization management.

Responsibilities

• Conducts utilization management reviews (prospective, concurrent, retrospective) to ensure medical necessity and align with policy.
• Collaborates with interdisciplinary teams to facilitate transitions of care and resolve issues.
• Maintains accurate documentation and communicates with members, providers, and regulators.

Skills

Nursing knowledge

Case management

Licensure

Health insurance knowledge

Communication skills

Computer skills

Documentation systems

Time management

Critical thinking

Education

Associate or Bachelor’s Degree in Nursing or related field

Tools

Microsoft Office

Outlook

Job description

Cambia Health Solutions is seeking a dedicated Utilization Management Nurse to support members from home in the US, with preference for Idaho and Utah residents. You will conduct prospective, concurrent, and retrospective reviews to promote quality, cost-effective outcomes, and appropriate payments for services.

Qualified candidates have a nursing degree, 3+ years in case/utilization management, and RN licensure.