Remote Utilization Management Nurse – RN

Cambia Health Solutions, Inc.; Provo (UT); Remoto; USD 48.000 - 79.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical coverage

Dental coverage

Vision coverage

Paid time off

401(k) plan

Descrizione del lavoro

Utilization Management Nurse at Cambia Health Solutions, Inc. works from home across Oregon, Washington, Idaho or Utah, with preference for Idaho/ Utah residents.

The role performs prospective, concurrent and retrospective reviews to ensure medical necessity and appropriate payments, collaborating with physician advisors and interdisciplinary teams. The position emphasizes clinical expertise, policy interpretation, and timely member communications while supporting quality improvement and

Competenze

• Knowledge of health insurance industry trends, technology and contractual arrangements.
• Excellent verbal, written and interpersonal communication.
• Ability to interpret policies and procedures clearly.
• Strong organizational and time management skills.

Mansioni

• Conducts utilization management reviews (prospective, concurrent, retrospective).
• Applies clinical expertise and evidence-based criteria to make determinations.
• Collaborates with interdisciplinary teams to facilitate transitions of care.
• Serves as a resource to internal and external customers with timely responses.

Conoscenze

Health care knowledge

Communication skills

Time management

Critical thinking

Formazione

RN license

Nursing degree (Associate or Bachelor's)

Strumenti

Microsoft Office

Outlook

Descrizione del lavoro

Utilization Management Nurse at Cambia Health Solutions, Inc. works from home across Oregon, Washington, Idaho or Utah, with preference for Idaho/ Utah residents.

The role performs prospective, concurrent and retrospective reviews to ensure medical necessity and appropriate payments, collaborating with physician advisors and interdisciplinary teams. The position emphasizes clinical expertise, policy interpretation, and timely member communications while supporting quality improvement and