Remote Utilization Management RN

Cambia Health; Tacoma (WA); Remote; USD 51,000 - 69,000; Full time

Benefits offered by this job

Work from home options

Health benefits

401(k) plan

Paid time off

Job summary

Cambia seeks an Utilization Management Nurse to work remotely from OR, WA, ID or UT with preference to current employees and residents of Idaho and Utah. You will perform prospective/concurrent/retrospective reviews to promote quality and cost-effective care while ensuring proper payment for services.

The role requires nursing licensure, 3+ years in case or utilization management, and collaboration with interdisciplinary teams to support transitions of care and compliant documentation.

Qualifications

• Associate or Bachelor's Degree in Nursing or related field.
• 3 years of case management or utilization management experience.
• Must hold licensure in a state and have at least 3 years of direct clinical care.
• May require licensure in Idaho, Oregon, Utah and Washington.

Responsibilities

• Conduct utilization management reviews to ensure medical necessity.
• Apply clinical criteria and consult physicians as needed.
• Collaborate with interdisciplinary teams to facilitate transitions of care.
• Provide timely responses to inquiries and maintain documentation.
• Identify improvement opportunities and participate in quality efforts.
• Protect confidentiality and communicate professionally with members.
• Manage workload to meet performance and corporate goals.

Skills

RN licensure

Case management

Utilization management

Clinical care

Education

Nursing degree

RN license

Tools

Microsoft Office

Outlook

Health records systems

Job description

Cambia seeks an Utilization Management Nurse to work remotely from OR, WA, ID or UT with preference to current employees and residents of Idaho and Utah. You will perform prospective/concurrent/retrospective reviews to promote quality and cost-effective care while ensuring proper payment for services.

The role requires nursing licensure, 3+ years in case or utilization management, and collaboration with interdisciplinary teams to support transitions of care and compliant documentation.