Embedded Care Management Nurse
Embedded Care Management Nurse
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Job Description
Embedded Care Management Nurse
Hybrid work within Washington or Oregon
Work duties performed at home and at Vancouver Clinic
Who We Are Looking For:
Every day Cambias dedicated team of Care Management RNs are living our mission to make health care easier and lives better. As a member of the Clinical Services team our Care Management RNs provide clinical care management (such as case management disease management and/or care coordination) to best meet the members specific healthcare needs and to promote quality and costeffective outcomes.Oversees a collaborative process with the member and those involved in the members care to assess plan implement coordinate monitor and evaluate care as needed all in service of creating a personfocused 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 costeffective outcomes and improve overall health and wellbeing Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
Associates or bachelors degree in nursing or related field
3 years of case management utilization management disease management or behavioral health case management 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 (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical care.
Must have at least one of the following: Certification as a case manager from the URACapproved list of certifications; or bachelors degree (or higher) in a health or human servicesrelated field (psychiatric RN or masters degree in behavioral health preferred for behavioral health care management); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management)
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.
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 evidencebased 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 plans effectiveness and making adjustments as needed.
#LIHybrid
The expected hiring range for a Embedded Care Management Nurse is $36.40 $49.20 an hour depending on skills experience education and training; relevant licensure / certifications; and performance history. The bonus target for this position is 10. The current full salary range for this role is $34.20 $55.70 an hour.
About Cambia
Working at Cambia means being part of a purposedriven awardwinning 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 personfocused health care. Whether were 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 cuttingedge 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 Cambiasupported 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 marketleading 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 companypaid holidays.
- Marketleading 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).
- Awardwinning 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.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobaccofree workplace. All qualified applicants will receive consideration for employment without regard to race color national origin religion age sex sexual orientation gender identity disability protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability please email . Information about how Cambia Health Solutions collects uses and discloses information is available in our .
Employment Type
Full-Time
