Care Management Clinician

This is a fully remote position, open to applicants in Idaho, +3 more states.

📋 Description

• Deliver clinical care management, which encompasses case management, disease management, and/or care coordination.

• Conduct assessments, planning, implementation, coordination, monitoring, and evaluation to determine member needs and assess outcomes.

• Utilize clinical expertise and evidence-based criteria to guarantee compliance with medical policy, medical necessity guidelines, and care standards.

• Operate within the scope of your professional license.

• Consult with physician advisors regarding clinically appropriate determinations.

• Act as a resource for both internal and external customers.

• Work collaboratively with various departments to address claims, quality of care, and issues related to members or providers.

• Identify problems or areas needing improvement and propose solutions.

• Engage in quality improvement initiatives.

• Respond professionally in writing or via phone to inquiries from members, providers, and regulatory bodies.

• Ensure the confidentiality of sensitive documents and matters.

• Maintain consistent and precise documentation.

• Plan, organize, and prioritize tasks to fulfill performance standards, corporate objectives, and deadlines.

⛳️ Requirements

• Associate or Bachelor's Degree in Nursing or a related field, or an equivalent combination of education and experience.

• A minimum of 3 years in case management, utilization management, disease management, or behavioral health case management.

• Current licensure or certification in a state or territory of the United States in a health or human services discipline that allows for independent assessments within the practice scope.

• At least 3 years (or full-time equivalent) of direct clinical care experience.

• At least one of the following: URAC-approved case manager certification; a Bachelor's degree or higher in a health or human services-related field; or a current unrestricted RN license for medical care management.

• Preferred: Psychiatric RN or a Master's degree in Behavioral Health for behavioral health care management.

• Understanding of trends, technology, and contractual arrangements within the health insurance industry.

• Proficient in general computer skills, including Microsoft Office, Outlook, and internet research.

• Familiarity with healthcare documentation systems.

• Excellent oral, written, interpersonal communication, and customer service skills.

• Capability to interpret policies and procedures, make decisions, and effectively communicate complex topics.

• Strong organizational and time management abilities with the capacity to manage workload independently.

• Critical thinking and decision-making aptitude.

• Experience with AI tools and technologies is highly desired.

• Reliable wired internet connection; satellite or cellular internet is not permitted.

• Minimum internet speeds of 5Mb upload and 10Mb download are required.

• Access to a personal mobile device for MFA is necessary.

• Successful completion of a background check.

🏝️ Benefits

• Competitive salary.

• Medical, dental, and vision coverage for employees and eligible family members, including mental health benefits.

• Annual employer contribution to a health savings account.

• Generous paid time off policies that vary by role and tenure.

• 10 company-paid holidays.

• Market-leading 401(k) plan with a significant company match.

• Potential for discretionary retirement contributions based on company performance, with no vesting period.

• Opportunities for bonuses.

• Up to 12 weeks of paid parental leave after 12 months of continuous service.

• Award-winning wellness programs that incentivize participation.

• Employee Assistance Fund.

• Benefits for commuting and parking.

• Work-from-home options available for most positions.

• Employee resource groups.

• Community outreach programs supported by Cambia.

• A personal mobile device is required for MFA setup.