Remote Care Management Nurse

Remote Care Management Nurse (Future Opportunities) Work from home within Oregon, Washington, Idaho or Utah. Who We Are Looking For Every day, Cambia’s dedicated team of Care Management RNs are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Care Management RN's provide clinical care management (such as case management, disease management, and/or care coordination) to best meet the member’s specific healthcare needs and to promote quality and cost‑effective outcomes. They oversee a collaborative process with the member and those involved in the member’s care to assess, plan, implement, coordinate, monitor, and evaluate care as needed – all in service of creating a person‑focused health care experience. Are you a Registered Nurse looking to transition out of bedside care and into a role that still utilizes your clinical expertise, but offers a fresh challenge? Is your goal to promote quality, cost‑effective outcomes and improve overall health and wellbeing? Then this role may be the perfect fit. Qualifications Nursing or health/human services degree (Associate's or Bachelor's minimum), or equivalent experience in lieu of a degree At least 3 years of direct clinical care or experience in case management, utilization management, disease management, auditing, or retrospective review Active, unrestricted licensure or certification in a U.S. state or territory that allows you to independently conduct assessments within your scope of practice – RN license required for medical care management Must be eligible for licensure in Idaho, Oregon, Utah, and Washington 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 oral, written and interpersonal communication and customer service skills Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively Strong organization and time management skills with the ability to manage workload independently Ability to think critically and make decisions within individual role and responsibility Experience with AI tools and technologies to enhance productivity and decision‑making in professional settings highly desired What You Will Do At Cambia Conduct case management activities, including assessment, planning, implementation, coordination, monitoring, and evaluation to identify and meet member needs Apply clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care, utilizing evidence‑based criteria and practicing within the scope of their license Collaborate with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identify problems or needed changes, recommending resolutions and participating in quality improvement efforts Serve as a resource to internal and external customers, responding to inquiries in a professional manner while protecting confidentiality of sensitive documents and issues Provide consistent and accurate documentation, ensuring compliance with performance standards, corporate goals, and established timelines Coordinate resources, organize, and prioritize assignments to meet goals and timelines Monitor and evaluate the effectiveness of case management plans, gathering sufficient information to determine the plan’s effectiveness and making adjustments as needed The expected hiring range for a Care Management Nurse is $36.80 – $49.80 per hour, depending on skills, experience, education, and training; relevant licensure/certifications; and performance history. The bonus target for this position is 10%. The full salary range for this role is $34.20 – $55.70 per hour. Please let me know if you have any questions. Benefits 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 Remote work requires a wired internet connection that is not satellite or cellular, with a minimum upload speed of 5 Mb/s and a minimum download speed of 10 Mb/s. 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. #J-18808-Ljbffr Cambia Health Solutions