Remote Rn Utilization Review Nurse Jobs in Portland, OR

Remote Care Management Nurse (Future Opportunities)

Work from home within Oregon, Washington, Idaho or Utah

{Also open to current BCBSND employees}

*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:

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

• Minimum 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

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.

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

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

Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.

• Oregon, Washington, Utah, and Idaho:The expected hiring range is$36.80 - $49.80 an hour, the full salary range is$34.20 - $55.70 an hour and the bonus target is10%.

• North Dakota:The expected hiring range is$35.21 - $47.63 an hour and the full salary range is$31.86 - $50.98 an hour.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

• 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 varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.