Utilization Review Jobs in Portland, OR (NOW HIRING)

Supervisor Utilization Management

Hybridrole(3days/weekin office)atourBurlington, Renton, Spokane, Vancouver, Portland, Medford, Salt Lake City, Boise, Lewiston, or Fargooffices.

Candidates mustresidewithin commutable distance of that location or be willing torelocate.

Build a career with purpose. JoinourCauseto create a person-focused and economically sustainable health care system.

What if your clinical expertise and leadership instincts could shape the standard of care for an entire team - and thousands of members at once? Are you a clinical professional who finds yourself naturally stepping up to guide others, streamline processes, and ask 'how do we make this better for the patient? Then this role may be the perfect fit.

• Bachelor's degree in Nursing or related field

• 3 years of leadership experience

• 5 years of clinical experience or equivalent combination of education and experience.

• Must have license or certification, in a state or territory of the United States in the health or human services-related field that allows the professional to conduct an assessment as permitted within the scope of practice of the discipline (e.g. medical vs. behavioral health)

• 3 years full time equivalent direct clinical care

• Current unrestricted Registered Nurse (RN) license in a state or territory of the United States

Skills and Attributes:

• Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.

• Ability to communicate effectively, verbally and in writing including with members, employer or provider groups.

• Ability to effectively develop and lead a team (including employees who may be in multiple locations or work remotely).

• Demonstrated experience in recognizing problems and effectively resolving complex issues.

• Familiarity with health insurance industry trends and technology.

• Demonstrated competency related to clinical utilization management and care management practices.

• Ability to apply best practices and designated standards.

• Knowledge of payment coding guidelines, as applicable (Payment Review only).

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

What You Will Do at Cambia:

• Assigns and prioritizes work, sets goals, and coordinates daily activities of the team. Provides regular updates and communication to staff through 1:1 and team meetings.

• Monitors individual and team results to ensure work is completed in a timely manner, in accordance with department standards and procedures, and is in compliance with medical policy and medical necessity guidelines.

• Assists in development of productivity and quality standards. May conduct or participate in compliance audits and report audit findings. Identifies and implements process improvements as needed.

• Acts as a resource for staff and others. Appropriately escalates issues and partners with other departments to resolve issues and remove barriers. Collaborates with physician advisors on complex case and coverage determination processes.

• Participates in the hiring process, provides on-going coaching, employee development and writing of performance reviews. Develops and maintains desk reference guides on work procedures. Ensures new hires complete necessary training. Assesses training needs and plays an active role in development of staff.

• Completes special projects as assigned and may provide back-up support to staff as needed.

• Maintains clinical competency and keeps current on medical practices, procedures and industry trends.

• May develop and present educational updates internally or to other departments.

• Seeks ideas and opportunities for continuous improvement, determines which opportunities should be pursued and implements improvements as appropriate.

FTEs Supervised

• 8-15

#LI-Hybrid

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.

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.