Utilization Management Nurse
$36.8 - $49.8 per hourCambia Health Solutions, Inc.
- # **Utilization Management Nurse****Work from home within Oregon, Washington, Idaho or Utah****Preference will be given to current employees and candidates who reside in Idaho and Utah** **Build a career with purpose. Join our** **Cause** **to create a person-focused and economically sustainable health care system.****Who We Are Looking For:** Every day, Cambia’s dedicated team of Nurses are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Utilization Management Nurses provide utilization management (such as prospective concurrent and retrospective review) to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes and appropriate payment for services – all in service of making our members’ health journeys easier. Are you a Nurse who has a passion for healthcare? Are you a Nurse who is ready to take your career to the next level and make a real difference in the lives of our members? Then this role may be the perfect fit.**What You Bring to Cambia:****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* Equivalent combination of education and experience* Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical care.* May need to have licensure in all four states served by Cambia: Idaho, Oregon, Utah, Washington.* Must have at least one of the following: Bachelor’s degree (or higher) in a health or human services-related field (psychiatric RN or Masters’ degree in Behavioral Health preferred for behavioral health); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management) **Skills and Attributes:** * Knowledge of health insurance industry trends, technology and contractual arrangements.* General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems.* Strong verbal, written and interpersonal communication and customer service skills.* Ability to interpret policies and procedures and communicate complex topics effectively.* Strong organizational and time management skills with the ability to manage workload independently.* Ability to think critically and make decisions within individual role and responsibility. **What You Will Do at Cambia:** * Conducts utilization management reviews (prospective, concurrent, and retrospective) to ensure medical necessity and compliance with policy and standards of care.* Applies clinical expertise and evidence-based criteria to make determinations and consults with physician advisors as needed.* Collaborates with interdisciplinary teams, case management, and other departments to facilitate transitions of care and resolve issues.* Serves as a resource to internal and external customers, providing accurate and timely responses to inquiries.* Identifies opportunities for improvement and participates in quality improvement efforts.* Maintains accurate and consistent documentation and prioritizes assignments to meet performance standards and corporate goals.* Protects confidentiality of sensitive documents and issues while communicating professionally with members, providers, and regulatory organizations. #LI-RemotePay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history. * Oregon, Washington, Utah, and Idaho: The expected hiring range is $36.80 – $49.80 an hour, the full salary range is $34.20 – $55.70 an hour and the bonus target is 10%.* North Dakota: The expected hiring range is $35.21 - $47.63 an hour and the full salary range is $31.86 - $50.98 an hour.**About Cambia** Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through. **Why Join the Cambia Team?** At Cambia, you can:* Work alongside diverse teams building cutting-edge solutions to transform health care.* Earn a competitive salary and enjoy generous benefits while doing work that changes lives.* Grow your career with a company committed to helping you succeed.* Give back to your community by participating in Cambia-supported outreach programs.* Connect with colleagues who share similar interests and backgrounds through our employee resource groups. We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more. In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: * Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.* Annual employer contribution to a health savings account.* Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.* Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).* Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).* Award-winning wellness programs that reward you for participation.* Employee Assistance Fund for those in need.* Commute and parking benefits. Learn more about our benefits. We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb. As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email View email address on click.appcast.io. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
- J-18808-Ljbffr Cambia Health Solutions, Inc.
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Utilization Management Nurse in Washington, UT vacancy
- Cambia Health Solutions, Inc. is seeking a Utilization Management Nurse to join our Clinical Services team. This remote role supports members in Oregon, Washington, Idaho or Utah, conducting prospective, concurrent and retrospective reviews to ensure medical necessity...SuggestedRemote job
- ...2 days ago Requisition ID: 2164 Lead Nursing Operations. Support Exceptional Pediatric... ..., transfers, discharges, and bed management. Respond to emergencies, critical incidents... ...decisions, including overtime and agency utilization, while maintaining safe patient care....SuggestedFull timeShift workNight shiftWeekend workAfternoon shift
$35.22 - $53.29 per hour
...Position, 20 Hours Per Week The Registered Nurse (RN) is a professional caregiver who... ...evaluating the care of patients. The staff RN utilizes the nursing process by use of technology,... ...care delivery through effectively managing time, supplies, and resources. Evaluate...SuggestedHourly payPart timeRemote workMonday to Friday$35.22 - $53.29 per hour
...Registered Nurse (RN) The Registered Nurse (RN) is a licensed professional caregiver who assumes responsibility and accountability... ..., implementation and evaluating care of patients. The staff RN utilizes the nursing process by use of technology, therapeutic intervention...SuggestedHourly payFull timeWork experience placementShift work$35.22 - $53.29 per hour
...Position, 20 Hours Per Week The Registered Nurse (RN) is a professional caregiver who... ...evaluating the care of patients. The staff RN utilizes the nursing process by use of technology,... ...care delivery through effectively managing time, supplies, and resources. Evaluate:...SuggestedHourly payPart timeRemote workMonday to Friday$65 per hour
...Kingman, AZ\nPosition Title: Registered Nurse Position Code: RN-_______\nDepartment: Nursing... ...with nursing standards and regulations. Utilizes the nursing process to make continuing... ...written communication skills.\n Able to manage technical business equipment i.e., phone,...Hourly payFull timeSeasonal workShift workNight shiftWeekend workAfternoon shiftKingman Regional Medical Center
Saint George, UT23 days ago$78k - $82k
...hole of the ATS (Applicant Tracking System). Now onto an exciting opportunity........... Join the Growth Journey: Your Role: RN Case Manager Location: St. George Communities Company: Strong Force Staffing (RPO for Client Agency) Job Brief: Strong Force Staffing, a leading...$37 per hour
...exceptional heart. We are seeking Registered Nurses (RNs) who are hardwired to serve—... ...specialized clinical tracks or step into management, we provide the tools, support, and funding... ..., real-time clinical documentation utilizing PointClickCare (PCC) EHR software. Regulatory...Temporary workNight shiftGenesiscareers
Hurricane, UT5 hours ago$32 - $36 per hour
...remote on-call shift required Are you a Licensed Practical Nurse (LPN) or Registered Nurse (RN) looking for a meaningful... ...ensure proper handling and compliance. Coordinate lab draws and manage medical documentation, including physician orders. Communicate...Hourly payTemporary workRemote workMonday to FridayShift workSunrise Services
Washington, UT2 days ago$38 - $45 per hour
...Advanced Home Health and Hospice of St. George About the job RN Case Manager, Home Health Company: Strong Force Staffing (Healthcare... ...Placement Partner , is seeking compassionate Home Health Registered Nurses (PRN) to support Advanced Home Health and Hospice of St. George...Hourly payPermanent employmentPart timeReliefFlexible hours$90 per unit
...Job Description Job Description Registered Nurse - In-Home Client Evaluations PRN | Per Visit | Flexible Scheduling Amada Senior... ...preferred ~ Experience in home health, geriatrics, case management, senior care, or similar settings preferred ~ Strong assessment...Extra incomeReliefWork at officeFlexible hoursShift workAMADA SENIOR CARE
Saint George, UT3 days ago$38 - $46 per hour
...team of professionals committed to improving the lives of those they serve and those they work with. What to Expect: Provide RN nursing services in a skilled nursing unit or facility; may include supervision of nurse assistants, medication passes and treatments...Full time$40 - $65 per hour
...Registered Nurse (RN) Opportunity Are you a Registered Nurse looking for supplemental income? We are looking for a talented RN to help us grow! Job starts as a PRN position, but you will set your own hours and the opportunity will grow as we bring on more clients....Weekly payExtra incomePart timeRelief- ...Outpatient RN CAP 1 The professional registered nurse Outpatient RN CAP 1 is an entry level designation into the Clinical Advancement Program (CAP). This position is accountable and responsible for the provision and coordination of clinically competent care including...
- Job Title/Position: Registered Nurse (RN) Reports To: Clinical Supervisor Job Description Summary The registered nurse plans, organizes... ...and implements prior to discharge of the patient. Acts as Case Manager when assigned by Clinical Supervisor and assumes responsibility...
- ...Registered Nurse Opportunity Are you a Registered Nurse looking for your next career opportunity providing life-changing services... ...working independently performing routine nursing procedures Managing patients care within the home setting Working in an EMR charting...
- Responsibilities Our PRN Registered Nurse (RN) administers skilled care visits to clients requiring intermittent professional services and teaches the client, family, and other members of the health care team. These services are performed in accordance with the physician...Full timeReliefFlexible hours
- ...: Part Time Job Shift: Any A Registered Nurse administers skilled nursing care to patients... ...and supervision of the Clinical Manager. Qualifications Graduate of an approved... ...management as assigned. Participates in utilization review of medical records as assigned. Gives...Part timeImmediate startShift workNight shiftWeekend work
- Dialysis Clinical Manager Registered Nurse - RN About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality... ...) coding. Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss...
- ...Registered Nurse (RN) - Home Health - PRN Primary Location: St. George, Utah Requisition Type: Home Health Patient Coverage Area: Cedar City and surrounding areas Overview Looking for a career that makes a difference every day? Discover a rewarding career at Enhabit...Full timeReliefFlexible hours
$190 per hour
...Job Description " Licensed Psychiatric Nurse Practitioner \n \n Wage: Up to $190/hour \n Did you know that you can build... ...autonomy over your practice, including setting your hours and managing your caseload. \n \n At this time, Headway can’t support mental...Bi-weekly payFull timeFor contractorsPrivate practiceFlexible hoursHeadway
Saint George, UT15 days ago$190 per hour
" Licensed Psychiatric Nurse Practitioner Wage: Up to $190/hour Did you know that you can build a flexible private practice... ...autonomy over your practice, including setting your hours and managing your caseload. At this time, Headway can’t support mental...Bi-weekly payFull timeFor contractorsPrivate practiceFlexible hoursHeadway
Saint George, UT23 hours ago$35.22 - $53.29 per hour
...Registered Nurse (RN) The Registered Nurse (RN) is a professional caregiver who assumes... ...the care of patients. The staff RN utilizes the nursing process by use of technology,... ...patient care delivery through effectively managing time, supplies, and resources. Evaluate...Hourly payFull timeShift workNight shift$130k - $160k
Avalon Health Care Management, Inc. has an exciting opportunity for an experienced Registered Nurse for a Regional Nurse Consultant position! Travel required. Avalon is seeking an experience skilled nursing facility director of nursing who is ready to take the next step...Full timeTemporary workLocal area- ...Nurse Consultant/Regional Director Of Clinical Operations Relocation to Northern New Mexico is required. The Nurse Consultant... ..., MDS Coordinator and others as necessary. Assists facility management with implementation of appropriate resident care policies & procedures...Relocation
- TotalWellness, one of the nation’s leading wellness companies, is looking for independent contractors to work corporate wellness screenings and vaccination events. We work with employers who are searching for ways to make their employees’ lives healthier and happier. Rather...For contractorsRelief
- ...HOME CARE REGISTERED NURSE Liberty Cares With Compassion At Liberty Home Care we know that following an illness, trauma or surgery, the ability to recover at home can greatly improve patient outcomes. Our healthcare professionals are dedicated to offering...
Liberty Health
Washington, UT2 days ago - ...Outpatient Dialysis Registered Nurse DaVita is seeking a Registered Nurse to join our outpatient dialysis team. In this role, you'... ...patient care in an outpatient dialysis setting Monitor patients, manage treatment plans, and respond to health changes Collaborate...Flexible hoursShift workDay shiftAfternoon shift2 days per week1 day per week
DaVita Labs
Hurricane, UT2 days ago - ...Outpatient RN CAP 1 The professional registered nurse Outpatient RN CAP 1 is an entry level designation into the Clinical Advancement Program (CAP). This position is accountable and responsible for the provision and coordination of clinically competent care including...
Fresenius Medical Care
Santa Clara, UT3 days ago - ...or Cedar City, UT**Must have at least one year of post-graduate nursing experience. Charge Nurse experience is highly desired but not... ...patient care in an outpatient dialysis settingMonitor patients, manage treatment plans, and respond to health changesCollaborate with...Flexible hoursShift workRotating shiftDay shiftAfternoon shift2 days per weekEarly shift1 day per week
DaVita
Hurricane, UT2 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Management Nurse. Be the first to apply!
Related searches
- management team Washington, UT
- construction management part time Washington, UT
- management jobs Washington, UT
- remote database management Washington, UT
- director managed services Washington, UT
- management opportunity Washington, UT
- sales management training program Washington, UT
- entry level management training Washington, UT
- IT performance management Washington, UT
- store management trainee Washington, UT