Utilization Management Nurse - R-5307_15-4185 - Masco Corporation
Pocatello, ID
About the Job
This job was posted by https://idahoworks.gov : For more information,
please see: https://idahoworks.gov/jobs/2272828
Utilization 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 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-Remote
The expected hiring rang for a Utilization Management Nurse is
$38.00 - $41.50 an hour depending on skills, experience, education,
and training; relevant licensure / certifications; and performance
history. The bonus target for this position is 10%. The current full
salary range for this role is $33.80 - $55.00 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 doin
please see: https://idahoworks.gov/jobs/2272828
Utilization 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 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-Remote
The expected hiring rang for a Utilization Management Nurse is
$38.00 - $41.50 an hour depending on skills, experience, education,
and training; relevant licensure / certifications; and performance
history. The bonus target for this position is 10%. The current full
salary range for this role is $33.80 - $55.00 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 doin
Source : Masco Corporation