Remote Care Management Nurse (Future Opportunities) - Cambia Health Solutions, Inc

Care Management Nurse (Future Opportunities)

Work from home within Oregon, Washington, Idaho or Utah

*Please be advised that this role is part of our candidate pool, which allows us to identify and attract exceptional talent for future opportunities. Although we may not have immediate openings, we invite you to submit your resume for consideration. By doing so, you will be included in our database and considered for all suitable positions as they become available, ensuring that you are among the first to be notified of new opportunities that match your skills and experience.*

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Who We Are Looking For:

Every day, Cambia's dedicated team of Care Management RN's 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. Oversees 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.

What You Bring to Cambia:

Qualifications:

• Associates or Bachelor's Degree in Nursing or related field

• 3 years of case management, utilization management, disease management, or behavioral health case management 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.

• Must have at least one of the following: Certification as a case manager from the URAC-approved list of certifications; or Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or Master's degree in Behavioral Health preferred for behavioral health care management); 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 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 decision within individual role and responsibility.

What You Will Do at Cambia:

• Conducts case management activities, including assessment, planning, implementation, coordination, monitoring, and evaluation to identify and meet member needs.

• Applies 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.

• Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions and participating in quality improvement efforts.

• Serves as a resource to internal and external customers, responding to inquiries in a professional manner while protecting confidentiality of sensitive documents and issues.

• Provides consistent and accurate documentation, ensuring compliance with performance standards, corporate goals, and established timelines.

• Coordinates resources, organizes, and prioritizes assignments to meet goals and timelines.

• Monitors and evaluates the effectiveness of case management plans, gathering sufficient information to determine the plan's effectiveness and making adjustments as needed.

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