Remote Utilization Management RN – Care & Outcomes

Cambia Health Solutions, Inc.; Eagle (ID); A distancia; USD 48.000 - 79.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental & vision coverage

401(k) with company match

Paid time off & holidays

Parental leave

Remote work options

Descripción de la vacante

Cambia Health Solutions, Inc. is seeking a Utilization Management Nurse to work from home supporting Oregon, Washington, Idaho or Utah.

You will perform prospective, concurrent and retrospective reviews to ensure medical necessity and appropriate payment for services, collaborating with physicians and care teams to improve outcomes. Ideal candidates hold an Associate or Bachelor’s in Nursing or a related field and have 3+ years of experience in case or utilization management, with active

Formación

• 3 years of case management, utilization management, disease management, auditing or retrospective review experience.
• Must have licensure or certification in a U.S. state/territory allowing independent assessment.
• RN license or equivalent with current unrestricted status where applicable.

Responsabilidades

• Conduct utilization management reviews (prospective, concurrent, retrospective) to ensure medical necessity and adherence to policy.
• Apply clinical criteria and consult physician advisors as needed.
• Collaborate with interdisciplinary teams to facilitate transitions of care.

Conocimientos

Case management

Utilization management

Disease management

Auditing

Retrospective review

Educación

Associate or Bachelor’s Degree in Nursing or related field

Herramientas

Microsoft Office

Outlook

Descripción del empleo

Cambia Health Solutions, Inc. is seeking a Utilization Management Nurse to work from home supporting Oregon, Washington, Idaho or Utah.

You will perform prospective, concurrent and retrospective reviews to ensure medical necessity and appropriate payment for services, collaborating with physicians and care teams to improve outcomes. Ideal candidates hold an Associate or Bachelor’s in Nursing or a related field and have 3+ years of experience in case or utilization management, with active