Care Management Clinician

Care Management Clinician Work from home within Idaho, Oregon, Utah, and Washington. Preference will be given to current employees and candidates who reside in 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 Care Management Clinician is living our mission to make health care easier and lives better. As a member of the Care Management team, our Care Management Clinician provides 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 – all in service of making our members’ health journeys easier.

Do you have strong organization and time management skills? Do you have a passion for serving others and learning new things? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

· Care Management Clinician would have a/an Associate or Bachelor's Degree in Nursing or related field and 3 years of case management, utilization management, disease management, or behavioral health case management experience or 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.
· Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:
· Performs essential case management activities—assessment, planning, implementation, coordination, monitoring, and evaluation—to identify member needs, set goals, execute actions, organize resources, and measure effectiveness of outcomes.
· Applies clinical expertise and judgment using evidence-based criteria to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care, while practicing within license scope.
· Consults with physician advisors to ensure clinically appropriate determinations and serves as a resource to internal and external customers.
· Collaborates with other departments to resolve claims, quality of care, and member or provider issues.
· Identifies problems or needed changes, recommends resolutions, and participates in quality improvement efforts.
· Responds professionally in writing or by phone to members, providers, and regulatory organizations…