Utilization Management Nurse Specialist

4 hours ago

Olympia, Washington, United States Cambia Health Solutions Full time
Job Title: Utilization Management Nurse

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

Key Responsibilities:
  • Conduct utilization management reviews to ensure medical necessity and compliance with policy and standards of care.
  • Apply clinical expertise and evidence-based criteria to make 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.
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.
What We Offer:
  • A competitive hourly rate of $38.00 - $41.50.
  • The opportunity to work from home within Oregon, Washington, Idaho, or Utah.
  • A dynamic and supportive work environment.

Cambia Health Solutions is an equal opportunity employer and welcomes applications from diverse candidates. If you are a motivated and detail-oriented individual with a passion for healthcare, we encourage you to apply for this exciting opportunity.

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