Remote Care Management Nurse

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. You will be included in our database and considered for all suitable positions as they become available.

About Cambia

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Cambia’s dedicated team of Care Management RNs live our mission to make health care easier and lives better. As a member of the Clinical Services team, our Care Management RNs 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.

Qualifications

• 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 that allows you to independently conduct assessments within your scope of practice — RN license required for medical care management
• Must be eligible for licensure in Idaho, Oregon, Utah, and Washington

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 decisions within individual role and responsibility
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Responsibilities

• 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

Pay

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 hour, the full salary range is $34.20 – $55.70 an hour, and the bonus target is 10%.

Benefits

• 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

Schedule

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.

As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company.