Remote Utilization Management Nurse – Transforming Care Outcomes

Cambia Health Solutions; Bend (OR); Remote; USD 51,000 - 69,000; Full time

Benefits offered by this job

Medical, dental & vision coverage

Health savings account contributions

Generous paid time off

Retirement plan with company match

Parental leave (up to 12 weeks)

Wellness programs

Employee Assistance Fund

Commute and parking benefits

Job summary

Cambia Health Solutions is seeking an Utilization Management Nurse to support care decisions for members across Oregon, Washington, Idaho, and Utah. You’ll review medical necessity, apply evidence-based criteria, and work with physicians and care teams to optimize outcomes and manage costs.

The role emphasizes strong clinical assessment, licensure in the US, and experience in case and utilization management, with flexible work-from-home options and regional pay structures.

Qualifications

• Associate or Bachelor’s degree in Nursing or related field.
• 3 years of case management, utilization management, disease management, auditing or retrospective review experience.
• Must have licensure in a US state and at least 3 years of direct clinical care.
• Possible licensure in Idaho, Oregon, Utah and Washington.

Responsibilities

• Conduct utilization management reviews to ensure medical necessity and compliance.
• Apply clinical expertise and evidence-based criteria to make determinations.
• Collaborate with interdisciplinary teams to facilitate transitions of care.
• Provide timely, accurate responses to inquiries and maintain documentation.
• Identify opportunities for improvement and participate in quality initiatives.

Skills

Case management

Utilization management

Nursing license

Clinical assessment

Interdisciplinary collaboration

Communication skills

AI tools experience

Education

Associate or Bachelor’s Degree in Nursing

RN license

State licensure in US health discipline

Tools

Microsoft Office

Outlook

Healthcare documentation systems

Job description

Cambia Health Solutions is seeking an Utilization Management Nurse to support care decisions for members across Oregon, Washington, Idaho, and Utah. You’ll review medical necessity, apply evidence-based criteria, and work with physicians and care teams to optimize outcomes and manage costs.

The role emphasizes strong clinical assessment, licensure in the US, and experience in case and utilization management, with flexible work-from-home options and regional pay structures.