Utilization Management Nurse
2 weeks ago
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 effective and efficient healthcare possible.
Key Responsibilities- Conduct thorough utilization 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.
- Provide accurate and timely responses to internal and external customers, serving as a resource for complex inquiries.
- Identify opportunities for improvement and participate in quality improvement efforts to enhance our services.
- Maintain accurate and consistent documentation, prioritizing assignments to meet performance standards and corporate goals.
- Protect confidentiality of sensitive documents and maintain professional communication with members, providers, and regulatory organizations.
- Associate or Bachelor's Degree in Nursing or related field.
- 3 years of experience in case management, utilization management, disease management, auditing, or retrospective review.
- Equivalent combination of education and experience.
- Licensure or certification in a health or human services discipline, with at least 3 years of direct clinical care experience.
- Ability to interpret policies and procedures, communicate complex topics effectively, and think critically to make informed decisions.
- Strong organizational and time management skills, with the ability to manage workload independently.
Cambia Health Solutions offers a competitive hourly rate of $38.00 - $41.50, depending on experience. We are a remote-friendly organization, and this role can be performed from home. If you are a motivated and detail-oriented nurse with a passion for healthcare, we encourage you to apply for this exciting opportunity.
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Nurse for Utilization Management
3 weeks ago
Yakima, Washington, United States Cambia Health Solutions Full timeUtilization Management Nurse PositionWe are seeking a dedicated **Utilization Management Nurse** to contribute significantly to the efficiency and effectiveness of healthcare delivery for our members. At **Cambia Health Solutions**, our focus is on delivering sustainable and person-centered healthcare solutions that truly impact lives.Key...
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Nurse for Utilization Management
4 weeks ago
Yakima, Washington, United States Cambia Health Solutions Full timeUtilization Management Nurse PositionWe are seeking a dedicated **Utilization Management Nurse** to play a vital role in ensuring that our members receive necessary healthcare services in a timely and effective manner. At Cambia Health Solutions, we prioritize delivering personalized and sustainable healthcare solutions that positively impact lives.Key...
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Nurse for Utilization Management
4 weeks ago
Yakima, Washington, United States Cambia Health Solutions Full timeUtilization Management Nurse PositionWe are seeking a dedicated Utilization Management Nurse to play a vital role in ensuring that our members receive necessary healthcare services in an efficient manner. At Cambia Health Solutions, we are focused on delivering patient-centered and sustainable healthcare solutions that significantly impact individuals'...
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Medical Director
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