Care Management Nurse

🕒 June 28

🥔 Idaho, Oregon, +1 more states – Remote

🥔 Idaho – Remote 🌲 Oregon – Remote ⛷️ Utah – Remote

💵 $34 - $55 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 27%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Cambia Health Solutions

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

Cambia Health Solutions is a nonprofit, mission-driven healthcare company based in Portland, Oregon, that operates consumer-focused health care and health insurance businesses and invests in health innovation. It serves as the parent organization for the Regence family of health plans and runs initiatives and subsidiaries focused on improving care delivery, providing insurance products, and developing digital health tools and services.

📋 Description

• Provide clinical care management, including case management, disease management, and/or care coordination • Assess, plan, implement, coordinate, monitor, and evaluate member care • Conduct case management activities 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 • Use evidence-based criteria and practice within the scope of licensure • Collaborate with physician advisors, internal and external customers, and other departments • Resolve claims, quality-of-care, member, and provider issues • Identify problems or needed changes, recommend resolutions, and participate in quality improvement efforts • Respond professionally to internal and external customer inquiries while protecting confidential information • Provide consistent and accurate documentation in compliance with performance standards, corporate goals, and timelines • Coordinate resources and organize and prioritize assignments • Monitor and evaluate case management plan effectiveness and adjust plans as needed

🎯 Requirements

• Nursing or health/human services degree (Associate's or Bachelor's minimum), or equivalent experience in lieu of a degree • Minimum 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 allowing independent assessments within scope of practice • RN license required for medical care management • Must be eligible for licensure in Idaho, Oregon, Utah, and Washington • Knowledge of health insurance industry trends, technology, and contractual arrangements • General computer skills, including Microsoft Office, Outlook, and internet search • Familiarity with health care documentation systems • Strong oral, written, 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; ability to manage workload independently • Critical-thinking and decision-making ability within role and responsibility • Experience with AI tools and technologies highly desired • Must have wired internet, not satellite or cellular, with minimum 5Mb upload and 10Mb download speeds for work-from-home option • Access to a personal mobile device for Multi-Factor Authentication • Background check required

🏖️ Benefits

• Medical, dental and vision coverage for employees and eligible family members, including mental health benefits • Annual employer contribution to a health savings account • Generous paid time off • 10 company-paid holidays • Market-leading 401(k) with company match • Potential discretionary retirement contribution based on company performance, with no vesting period • Up to 12 weeks of paid parental time off after 12 months of continuous service • Award-winning wellness programs • Employee Assistance Fund • Commute and parking benefits • Bonus opportunities • Work-from-home options • Employee resource groups • Cambia-supported community outreach programs • Wired internet connection and personal mobile device required for work-from-home setup