Utilization Management Nurse

3 weeks ago

Lewiston, Idaho, United States Cambia Health Solutions Full time
About the Role:

Cambia Health Solutions is seeking a skilled Utilization Management Nurse to join our Clinical Services team. As a key member of our team, you will play a critical role in ensuring that our members receive the most appropriate and cost-effective care possible.

Key Responsibilities:
  • Conduct thorough utilization management reviews to ensure medical necessity and compliance with policy and standards of care.
  • Apply clinical expertise and evidence-based criteria to make informed determinations and consult with physician advisors as needed.
  • Collaborate with interdisciplinary teams, case management, and other departments to facilitate transitions of care and resolve issues.
  • Serve as a resource to internal and external customers, providing accurate and timely responses to inquiries.
  • Identify opportunities for improvement and participate in quality improvement efforts.
  • Maintain accurate and consistent documentation and prioritize assignments to meet performance standards and corporate goals.
  • Protect confidentiality of sensitive documents and issues while communicating professionally with members, providers, and regulatory organizations.
Requirements:
  • Associate or Bachelor's Degree in Nursing or related field.
  • 3 years of case management, utilization management, disease management, auditing or retrospective review 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.
  • May need to have licensure in all four states served by Cambia: Idaho, Oregon, Utah, Washington.
  • Must have at least one of the following: Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or Masters' degree in Behavioral Health preferred for behavioral health); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management).
What We Offer:
  • Competitive base pay.
  • Market-leading 401(k) with a significant company match.
  • Bonus opportunities.
  • Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
  • Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
  • Annual employer contribution to a health savings account.
  • Award-winning wellness programs that reward you for participation.
  • Employee Assistance Fund for those in need.
  • Commute and parking benefits.

  • Nurse Case Manager

    4 weeks ago

    Lewiston, Idaho, United States Delta Companies Full time

    Job Title: Registered NurseWe are seeking a skilled Registered Nurse to join our team at Delta Companies. As a Registered Nurse, you will be responsible for providing high-quality patient care and working collaboratively with our healthcare team to achieve exceptional patient outcomes.Responsibilities:Provide direct patient care and develop individualized...

  • Nurse Case Manager

    4 weeks ago

    Lewiston, Idaho, United States Delta Companies Full time

    Job OpportunityWe are seeking a skilled Registered Nurse to join our team at Delta Companies. As a Registered Nurse, you will be responsible for providing high-quality patient care and working collaboratively with our healthcare team.ResponsibilitiesProvide direct patient care and develop individualized care plansCollaborate with healthcare team members to...

  • Nurse Case Manager

    4 weeks ago

    Lewiston, Idaho, United States Delta Companies Full time

    Job OpportunityWe are seeking a skilled Registered Nurse to join our team at Delta Companies. As a Registered Nurse, you will be responsible for providing high-quality patient care and working collaboratively with our healthcare team.ResponsibilitiesProvide patient care and education to patients and familiesCollaborate with healthcare team members to develop...

  • Nurse Case Manager

    4 weeks ago

    Lewiston, Idaho, United States Delta Companies Full time

    Job OpportunityWe are seeking a skilled Registered Nurse to join our team at Delta Companies. As a Registered Nurse, you will be responsible for providing high-quality patient care and working collaboratively with our healthcare team.ResponsibilitiesProvide patient care and education to patients and familiesCollaborate with healthcare team members to develop...

  • Nurse Case Manager

    4 weeks ago

    Lewiston, Idaho, United States Delta Companies Full time

    Job OpportunityWe are seeking a skilled Registered Nurse to join our team at Delta Companies. As a Registered Nurse, you will be responsible for providing high-quality patient care and working collaboratively with our healthcare team.ResponsibilitiesProvide direct patient care and develop individualized care plansCollaborate with healthcare professionals to...

  • Nurse Case Manager

    4 weeks ago

    Lewiston, Idaho, United States Delta Companies Full time

    Job OpportunityWe are seeking a skilled Registered Nurse to join our team in Northern Idaho. As a Registered Nurse, you will be responsible for providing high-quality patient care and working collaboratively with our healthcare team.ResponsibilitiesProvide direct patient care and develop individualized care plansCollaborate with healthcare professionals to...

  • Travel Nurse RN

    3 weeks ago

    Lewiston, Idaho, United States SH ST. JOSEPH REG MED CTR Full time

    Job SummaryWe are seeking a skilled Medical-Surgical Nurse to join our team at SH ST. JOSEPH REG MED CTR. As a Med/Surg Nurse, you will provide direct and individualized nursing care to patients based on the application of scientific nursing principles.ResponsibilitiesConsults and coordinates with the healthcare team to assess, plan, implement, and evaluate...

  • Financial Operations Manager

    2 days ago

    Lewiston, Idaho, United States The Seer Group Full time

    Controller Position SummaryThe Seer Group is seeking an experienced Controller to oversee all financial, accounting, and HR tasks, as well as some reporting and excise tax and licensing compliance. The successful candidate will work in cooperation with and be supported by a management team that includes accounting and HR professionals.Key...

  • Restaurant Operations Manager

    2 weeks ago

    Lewiston, Idaho, United States KFC Full time

    Assistant Manager Role at KFCKFC Corporation, a renowned brand with a rich history of success and innovation, is seeking an experienced Assistant Manager to join their team. As a key member of the restaurant management team, you will be responsible for leading the team to achieve success metrics and providing exceptional customer service.Key...

  • Travel Nurse RN

    1 month ago

    Lewiston, Idaho, United States Cynet Health Full time

    Job Title: Registered Nurse (RN)Job Specialty: Medical-SurgicalJob Duration: 13 WeeksShift: 07:00-19:30Guaranteed Hours:Experience: Minimum 2 Years of Med/Surg ExperienceLicense: Must have RN or Multi-State Compact LicenseCertifications: Must have BLS Certifications through the American Heart AssociationKey Responsibilities:Provide direct and individualized...

  • Emergency Room Nurse

    3 weeks ago

    Lewiston, Idaho, United States Cross Country Nurses Full time

    Emergency Room Nurse Job OpportunityCross Country Nurses is seeking a skilled Emergency Department nurse for a travel nursing assignment in Lewiston, Idaho.Job DetailsShift: 12 hours, nightsEmployment Type: TravelAs an Emergency Room nurse, you will be responsible for providing high-quality patient care in a fast-paced environment. You will assess patients'...

  • Traveling Pharmacist

    4 weeks ago

    Lewiston, Idaho, United States TotalMed Case Management Staffing Full time

    Job DetailsTotalMed Case Management Staffing is seeking a skilled Pharmacist to fill a travel position in Lewiston, Idaho.Job RequirementsSpecialty: PharmacistDiscipline: Allied Health ProfessionalDuration: 10 weeks40 hours per weekShift: 8 hours, eveningsEmployment Type: TravelAbout the PositionWe are seeking a highly qualified Hospital-Pharmacist for an...

  • Commercial Construction Project Manager

    4 weeks ago

    Lewiston, Idaho, United States gpac Full time

    Job Title: Commercial Construction Superintendent Job Summary: We are seeking a highly skilled Commercial Construction Superintendent to join our team at GPAC. As a key member of our construction team, you will be responsible for overseeing the day-to-day operations of large commercial construction projects. Your expertise will be instrumental in ensuring...

  • Commercial Construction Project Manager

    1 month ago

    Lewiston, Idaho, United States gpac Full time

    Job Title: Commercial Construction Superintendent Job Summary: We are seeking an experienced Commercial Construction Superintendent to join our team at GPAC. As a key member of our construction team, you will be responsible for overseeing the day-to-day operations of large commercial construction projects. Your expertise will be instrumental in ensuring...

  • Commercial Construction Project Manager

    1 month ago

    Lewiston, Idaho, United States gpac Full time

    Job Title: Commercial Construction Superintendent Job Summary: We are seeking a highly skilled Commercial Construction Superintendent to join our team at GPAC. As a key member of our construction team, you will be responsible for overseeing the day-to-day operations of large commercial construction projects. Your expertise will be instrumental in ensuring...

  • Emergency Department Nurse

    2 weeks ago

    Lewiston, Idaho, United States Cynet Health Full time

    Job Title:Registered Nurse - Emergency DepartmentJob Summary:Cynet Health is seeking a skilled Registered Nurse to join our team in the Emergency Department. As a key member of our healthcare team, you will provide high-quality patient care and work collaboratively with other healthcare professionals to ensure the best possible...

  • Travel Nurse RN Position

    3 weeks ago

    Lewiston, Idaho, United States United Staffing Solutions Full time

    Job Title: Travel Nurse RNUnited Staffing Solutions is seeking a skilled Travel Nurse RN to join their team in Lewiston, Idaho.Job Description & RequirementsSpecialty: Emergency DepartmentDiscipline: Registered NurseShift: 12 hours, nightsEmployment Type: TravelThe Registered Nurse will be responsible for providing high-quality patient care in the Emergency...

  • Senior Director Operations/General Manager

    3 days ago

    Lewiston, Idaho, United States CHS Inc Full time

    Senior Director of Operations/GM OpportunityCHS Inc., a leading global agribusiness, is seeking a seasoned Senior Director of Operations/GM to lead our Ag retail division. This exciting opportunity is based in Idaho and Washington, with the main headquarters in Lewiston, ID.Key ResponsibilitiesManage the business unit operation to provide patrons with...

  • Nurse Practitioner

    3 weeks ago

    Lewiston, Idaho, United States Northwest Children's Home Full time

    Job Title: Registered NurseWe are seeking a skilled Registered Nurse to join our team at Northwest Children's Home, Inc. as a Behavioral Health Clinician. In this role, you will provide professional nursing care to emotionally disturbed and/or mentally ill clients receiving treatment and rehabilitative services.Responsibilities:Under general supervision,...

  • Occupational Health Nurse

    1 week ago

    Lewiston, Idaho, United States WorkCare Full time

    Job SummaryWe are seeking a highly skilled and dedicated Occupational Health Nurse to join our team at WorkCare. As an onsite medical professional, you will provide top-notch medical care and support to our employees, ensuring their health and well-being in the workplace.ResponsibilitiesProvide on-site medical treatment and management of injuries and...