Remote Utilization Nurse: Case Management

Cambia Health Solutions, Inc.; Oregon; Ibrido; USD 51.000 - 69.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental and vision coverage

Employer 401(k) plan with companymatch

12 weeks paid parental leave

Wellness programs

Employee Assistance Fund

Commute and parking benefits

Descrizione del lavoro

Cambia Health Solutions, Inc. seeks an Utilization Management Nurse to support member care from home serving Oregon, Washington, Idaho or Utah. The role focuses on prospective, concurrent and retrospective reviews to promote medical necessity and appropriate payment for services.

You will apply clinical criteria, consult with physician advisors as needed, and work with interdisciplinary teams to ensure smooth transitions of care while maintaining accurate documentation.

Competenze

• 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 or certification in a US state/territory to conduct assessments independently.
• May require licensure in Idaho, Oregon, Utah and Washington.
• One of: Bachelor's degree in health-related field or RN license with active/unrestricted status.

Mansioni

• Conduct utilization management reviews (prospective, concurrent, and retrospective) to ensure medical necessity and policy adherence.
• Apply clinical criteria and consult physician advisors as needed.
• Collaborate with interdisciplinary teams to facilitate transitions of care and address issues.
• Serve as a resource to internal/external customers with timely responses.
• Identify opportunities for improvement and participate in quality initiatives.
• Maintain accurate documentation and manage workload to meet performance goals.

Conoscenze

Utilization management

Case management

Communication skills

Health insurance knowledge

Independent decision making

Microsoft Office / Outlook

Formazione

Associate or Bachelor's Degree in Nursing or related field

RN license

3 years of direct clinical care experience (or equivalent)

Strumenti

Microsoft Office

Outlook

Descrizione del lavoro

Cambia Health Solutions, Inc. seeks an Utilization Management Nurse to support member care from home serving Oregon, Washington, Idaho or Utah. The role focuses on prospective, concurrent and retrospective reviews to promote medical necessity and appropriate payment for services.

You will apply clinical criteria, consult with physician advisors as needed, and work with interdisciplinary teams to ensure smooth transitions of care while maintaining accurate documentation.