Oncology Care Management Nurse

Cambia Health Solutions

1d•$32 - $57•Remote

About The Position

Cambia’s Care Management RN works as part of the Clinical Services team to provide clinical care management, including case management, disease management, and care coordination, tailored to members’ healthcare needs and intended to promote quality and cost-effective outcomes. The role oversees a collaborative process with members and others involved in their care to assess, plan, implement, coordinate, monitor, and evaluate care. This role is suited to a Registered Nurse seeking to apply clinical expertise outside bedside care while supporting members’ health and wellbeing. The position works from home within Oregon, Washington, Idaho, or Utah. Preference is given to current employees and candidates residing in Idaho or Utah. Employees working from home must have a wired, non-satellite and non-cellular internet connection with at least 5 Mb upload and 10 Mb download speeds, and access to a personal mobile device for setting up required Multi-Factor Authentication.

Requirements

Nursing or health/human services degree (associate’s or bachelor’s minimum), or equivalent experience in lieu of a degree.
At least 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 permits independent assessments within the scope of practice; an RN license is required for medical care management.
Must be eligible for licensure in Idaho, Oregon, Utah, and Washington.
Knowledge of health insurance industry trends, technology, and contractual arrangements.
General computer skills, including Microsoft Office, Outlook, and internet search.
Familiarity with health care documentation systems.
Strong oral, written, 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, including the ability to manage workload independently.
Ability to think critically and make decisions within the individual role and responsibility.

Nice To Haves

Experience with AI tools and technologies to enhance productivity and decision-making in professional settings.

Responsibilities

Conduct case management activities, including assessment, planning, implementation, coordination, monitoring, and evaluation, to identify and meet member needs.
Apply clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care, using evidence-based criteria and practicing within the scope of the license.
Collaborate with physician advisors, internal and external customers, and other departments to resolve claims, quality-of-care, member, or provider issues; identify problems or needed changes; recommend resolutions; and participate in quality improvement efforts.
Serve as a resource to internal and external customers and respond to inquiries professionally while protecting confidential documents and sensitive issues.
Provide consistent and accurate documentation in compliance with performance standards, corporate goals, and established timelines.
Coordinate resources, organize and prioritize assignments, and meet goals and timelines.
Monitor and evaluate the effectiveness of case management plans, gather information to determine effectiveness, and adjust plans as needed.

Benefits

Competitive salary and bonus opportunities.
Medical, dental, and vision coverage for employees and eligible family members, including mental health benefits.
Annual employer contribution to a health savings account.
Paid time off and 10 company-paid holidays.
401(k) retirement plan with company match and potential discretionary contribution based on company performance.
Up to 12 weeks of paid parental time off, subject to eligibility requirements.
Wellness programs.
Employee Assistance Fund.
Commute and parking benefits.
Employee resource groups and opportunities to participate in company-supported community outreach programs.