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Utilization and Care Management Nurse

CAMBIA HEALTH SOLUTIONS, INC.

BLUFFDALE, UT(remote)

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JOB DETAILS
SALARY
$36.80–$49.80 Per Hour
SKILLS
Artificial Intelligence (AI), Auditing, Behavioral Health, Case Management, Clinical Medicine, Communication Skills, Computer Skills, Consulting, Customer Support/Service, Disease Prevention and Control, Documentation, Establish Priorities, Health Economics, Health Insurance, Healthcare, Human Health, Industry/Trade Analysis, Internet Search, Internet/Online Service, Interpersonal Skills, Leading Edge Technology, Loans, Mail Processing, Microsoft Office, Microsoft Outlook, Nursing, Organizational Skills, Patient Care, Presentation/Verbal Skills, Problem Solving Skills, Psychiatry and Mental Health, Quality Management, Registered Nurse (RN), Regulations, Standards of Care, Systems Maintenance, Time Management, Utilization Management, Work From Home, Writing Skills
LOCATION
BLUFFDALE, UT
POSTED
Today
Job Title: Utilization and Care Management Nurse Description: ****Utilization and Care Management Nurse**** ****Work from home within Oregon, Washington, Idaho or 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 and Care Management Nurses provide utilization and care management (such as prospective concurrent, retrospective review, post-discharge care coordination) 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. - Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired - 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. - Participate in care management to identify and coordinate health care needs and gaps for members during the period of discharge from a facility until 30 days post discharge. - Applies clinical expertise and evidence-based criteria to make determinations and consults with physician advisors as needed. - Collaborates with interdisciplinary teams, case management, and ot her 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-Remote Pay 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 hourand the full salary range is$34.20 - $55.70 an hour.   - The bonus target for this position is10%. **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. 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 o rientation, 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 CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. What Wage are you offering? 36.80 to 49.80 per Yearly

About the Company

C

CAMBIA HEALTH SOLUTIONS, INC.

Cambia Health Solutions is a family of companies headquartered in Portland, Oregon, working to create a person-focused and economically sustainable health care system. Through our health plans, innovative technology and strategic investments, we are delivering consumer-centric solutions that: • help people achieve better health and well-being • make health care more available, affordable and accessible • are easily understood by everyone We put people at the heart of everything we do. Our company reaches more than 70 million Americans nationwide, including more than two million people in the Pacific Northwest who are enrolled in our regional health plans.
COMPANY SIZE
5,000 to 9,999 employees
INDUSTRY
Healthcare Services
FOUNDED
1940
WEBSITE
https://www.cambiahealth.com/careers