Job Description

Care Management Nurse or Social Worker
Work from home within Oregon, Washington, Idaho or Utah
Build a career with purpose. Join our to create a person-focused and economically sustainable health care system.
Who We Are Looking For:
Every day, Cambia's dedicated team of clinical professionals are living our mission to make health care easier and lives better. As a member of the Care Management team, our Care Management Clinicians 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 making our members' health journeys easier.
Are you a dedicated clinical professional passionate about making healthcare more accessible and effective? Are you ready to make a meaningful impact on members' health journeys every day? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
Associate or Bachelor's Degree in Nursing, Behavioral Health, or related field
3 years of case management, utilization management, disease management, or behavioral health case management experience or 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
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
Ability to interpret policies and procedures
Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
Strong oral, written and interpersonal communication and customer service skills
Ability to 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:
Collect in-depth information about member situations and functioning to identify individual needs, then develop specific objectives, goals, and actions to address those needs
Execute case management activities while organizing, securing, integrating and modifying resources to accomplish established goals
Gather information to determine plan effectiveness and measure success in reaching desired outcomes
Apply clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care using evidence-based criteria that incorporates current and validated clinical research findings
Practice within scope of license and consult with physician advisors to ensure clinically appropriate determinations
Serve as a resource to internal and external customers, collaborate with other departments to resolve claims, quality of care, member or provider issues, and respond professionally to members, providers and regulatory organizations while protecting confidentiality
Identify problems or needed changes, recommend resolutions, participate in quality improvement efforts, and provide consistent, accurate documentation
Plan, organize and prioritize assignments to comply with performance standards, corporate goals, and established timelines
#LI-Remote
The expected hiring range for a Care Management Nurse or Social Worker is $38.00 - $41.50 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 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 .
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 employer dedicated to a drug and tobacco-free 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 .

Skills Required