Care Management Nurse

🕒 June 28

🥔 Idaho, Oregon, +2 more states – Remote

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

💵 $31 - $57 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 55%

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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 care coordination • Assess, plan, implement, coordinate, monitor, and evaluate member care • Promote quality and cost-effective health outcomes • Apply clinical expertise and judgment to comply with medical policy, medical necessity guidelines, and accepted standards of care • 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 to internal and external customer inquiries professionally while protecting confidential information • Maintain accurate documentation in compliance with performance standards, corporate goals, and timelines • Coordinate resources and prioritize assignments to meet goals and deadlines • Monitor 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 skills • Experience with AI tools and technologies highly desired • Wired internet connection required; satellite or cellular internet is not accepted • Minimum internet speed of 5 Mb upload and 10 Mb download • Access to a personal mobile device for MFA • Background check required

🏖️ Benefits

• Competitive salary • 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 varying by role and tenure • 10 company-paid holidays • Market-leading retirement plan with company match on 401(k) contributions • 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 that reward participation • Employee Assistance Fund • Commute and parking benefits • Bonus opportunities • Work-from-home options • Employee resource groups • Cambia-supported community outreach programs • Flexible wired internet work-from-home arrangement • Personal mobile device access for Multi-Factor Authentication