Utilization Management Nurse

Cambia Health Solutions; Idaho; Remote; USD 10,000 - 60,000; Full time

Job summary

An established industry player in healthcare is seeking a Utilization Management Nurse to join their Clinical Services team. This remote role offers the opportunity to make a significant impact by conducting utilization reviews, collaborating with interdisciplinary teams, and applying clinical expertise to ensure quality care. With a competitive hourly wage and a supportive culture that promotes professional growth, this position is perfect for those passionate about transforming healthcare. Join a purpose-driven organization committed to innovation and compassion, where your contributions will help shape the future of healthcare.

Benefits

Health coverage

Retirement plans

Paid time off

Wellness programs

Qualifications

• 3+ years of experience in case management or utilization management.
• State licensure or certification for independent assessment.

Responsibilities

• Conduct utilization reviews to ensure medical necessity.
• Coordinate with teams to facilitate care transitions.

Skills

Knowledge of health insurance industry trends

Proficiency with Microsoft Office

Healthcare documentation systems

Strong communication skills

Organizational skills

Critical thinking

Decision-making abilities

Education

Associate Degree in Nursing

Bachelor’s Degree in Nursing

Tools

Healthcare documentation systems

Microsoft Office

Job description

Join to apply for the Utilization Management Nurse role at Cambia Health Solutions

Work from home within Oregon, Washington, Idaho, or Utah.

About the Role

As part of Cambia’s Clinical Services team, Utilization Management Nurses provide reviews (prospective, concurrent, and retrospective) to meet healthcare needs, promote quality, and ensure cost-effective outcomes. This role involves collaborating with interdisciplinary teams, applying clinical expertise, and maintaining accurate documentation to support members' health journeys.

Qualifications

• Associate or Bachelor’s Degree in Nursing or related field
• At least 3 years of experience in case management, utilization management, or related areas
• State licensure or certification permitting independent assessment
• RN license or higher in relevant states

Skills and Attributes

• Knowledge of health insurance industry trends
• Proficiency with Microsoft Office and healthcare documentation systems
• Strong communication and organizational skills
• Critical thinking and decision-making abilities

Key Responsibilities

• Conduct utilization reviews to ensure medical necessity and compliance
• Use clinical expertise to make determinations and consult with physicians
• Coordinate with teams to facilitate care transitions
• Maintain professional documentation and confidentiality

Compensation and Benefits

The hourly range is $38.00 - $41.50, with a bonus target of 10%. Benefits include health coverage, retirement plans, paid time off, wellness programs, and more. Remote work is supported with required internet specifications.

About Cambia

We are a purpose-driven organization committed to transforming healthcare through innovation and compassion, offering a supportive culture and growth opportunities.

Why Join Us?

• Work with diverse, innovative teams
• Competitive salary and benefits
• Career growth opportunities
• Community involvement

We are an equal opportunity employer and support a drug-free workplace. For accommodations, contact [e-mail].