This job was posted by https://idahoworks.gov : For more information,
please see: https://idahoworks.gov/jobs/2343672 Care Management Nurse
(Future Opportunities)
Work from home within Oregon, Washington, Idaho or Utah
*Please be advised that 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. By doing so, you will be
included in our database and considered for all suitable positions as
they become available, ensuring that you are among the first to be
notified of new opportunities that match your skills and experience.*
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 RN\'s 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. 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.
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.
What You Bring to Cambia:
Qualifications:
- Associates or Bachelor\'s Degree in Nursing or related field
- 3 years of case management, utilization management, disease
management, or behavioral health case management experience
- 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.
What You Will Do at Cambia:
- 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.
#LI-Remote
The expected hiring range for a Care Management Nurse is \$38.00 -
\$41.50 an hour depending on skills, experience, education, and
training; relevant licensure / certificati
