Remote Care Management Nurse

Remote Care Management Nurse (Future Opportunities)

Work from home within Oregon, Washington, Idaho or Utah.

Every day, Cambia’s dedicated team of Care Management RNs are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Care Management RN's 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.

They oversee 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.

Are you a Registered Nurse looking to transition out of bedside care and into a role that still utilizes your clinical expertise, but offers a fresh challenge? Is your goal to promote quality, cost‑effective outcomes and improve overall health and wellbeing? Then this role may be the perfect fit.

• Nursing or health/human services degree (Associate's or Bachelor's minimum), or equivalent experience in lieu of a degree
• At least 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

• 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

• Conduct case management activities, including assessment, planning, implementation, coordination, monitoring, and evaluation 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, utilizing evidence‑based criteria and practicing within the scope of their license
• Collaborate with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identify problems or needed changes, recommending resolutions and participating in quality improvement efforts
• Serve as a resource to internal and external customers, responding to inquiries in a professional manner while protecting confidentiality of sensitive documents and issues
• Provide consistent and accurate documentation, ensuring compliance with performance standards, corporate goals, and established timelines
• Coordinate resources, organize, and prioritize assignments to meet goals and timelines
• Monitor and evaluate the effectiveness of case management plans, gathering sufficient information to determine the plan’s effectiveness and making adjustments as needed

The expected hiring range for a Care Management Nurse is $36.80 – $49.80 per hour, depending on skills, experience, education, and training; relevant licensure/certifications; and performance history. The bonus target for this position is 10%. The full salary range for this role is $34.20 – $55.70 per hour. Please let me know if you have any questions.

• 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…