Remote Utilization Management Nurse - Make Healthcare More Efficient

Cambia Health; Portland (OR); Remote; USD 48,000 - 79,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

401(k) with company match

Parental leave

Wellness programs

Employee Assistance Fund

Job summary

Cambia Health is seeking an Utilization Management Nurse to work remotely within Oregon, Washington, Idaho or Utah. The role focuses on prospective, concurrent, and retrospective reviews to ensure medical necessity and appropriate payment for services.

Licensure in applicable states is required, with strong clinical assessment and documentation skills. The position emphasizes collaboration with care teams, adherence to policies, and opportunities to contribute to quality improvement while

Qualifications

• Associate or Bachelor’s degree in Nursing or related field.
• RN license in a U.S. state with current, unrestricted status.
• Minimum 3 years in case management or utilization management or related field.

Responsibilities

• Conduct utilization management reviews (prospective, concurrent, retrospective).
• Apply clinical criteria to determine medical necessity and communicate with physicians.
• Collaborate with interdisciplinary teams to facilitate transitions of care.
• Respond to inquiries with accurate, timely information for members and providers.
• Identify opportunities for quality improvement and participate in initiatives.
• Maintain accurate documentation and manage assignments to meet standards.
• Protect confidentiality and comply with regulatory requirements.

Skills

Nursing knowledge

Health insurance trends

Policy interpretation

Communication skills

Time management

Documentation systems

Interdisciplinary collaboration

Education

Associate or Bachelor’s in Nursing

RN license

Tools

Microsoft Office

Outlook

Job description

Cambia Health is seeking an Utilization Management Nurse to work remotely within Oregon, Washington, Idaho or Utah. The role focuses on prospective, concurrent, and retrospective reviews to ensure medical necessity and appropriate payment for services.

Licensure in applicable states is required, with strong clinical assessment and documentation skills. The position emphasizes collaboration with care teams, adherence to policies, and opportunities to contribute to quality improvement while