Registered Nurse (RN) - Med Surg
Cambia Health
Portland, OR

Maternity Care Management Nurse

Maternity Care Management Nurse Work from home within Oregon, Washington, Idaho or Utah Who We Are Looking For: Every day, Cambia's dedicated team of Care Management RN's are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Care Management RN's 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 creating a person-focused health care experience. Are you a Maternity RN 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, cost-effective outcomes and improve overall health and wellbeing? Then this role may be the perfect fit. What You Bring to Cambia: Qualifications: * Associates or Bachelor's 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 URAC-approved list of certifications; or Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or Master's 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: * Healthcare Industry Acumen: Possesses knowledge of current trends, technological advancements, and contractual agreements within the health insurance industry, enabling informed decision-making and effective navigation of complex healthcare systems. * Technical Competence: Demonstrates proficiency in general computer skills, including Microsoft Office, Outlook, and internet search capabilities, with familiarity with healthcare documentation systems, such as electronic health records (EHRs) and practice management systems (PMS). * Effective Communication and Interpersonal Skills: Exhibits strong oral, written, and interpersonal communication skills, with the ability to provide exceptional customer service, empathize with patients and families, and collaborate with interdisciplinary teams to achieve optimal patient outcomes. * Policy Interpretation and Decision-Making: Possesses the ability to accurately interpret and apply organizational policies and procedures, make informed decisions, and communicate complex information effectively to patients, families, and healthcare teams. * Autonomous Workload Management: Demonstrates strong organization and time management skills, with the ability to prioritize tasks, manage workload independently, and maintain productivity in a fast-paced healthcare environment. * Critical Thinking and Decision-Making: Applies critical thinking skills to make informed decisions within individual role and responsibility, weighing the impact of decisions on patient care, organizational operations, and healthcare outcomes. What You Will Do at Cambia: * Comprehensive Case Management: Responsible for assessment, planning, implementation, coordination, monitoring, and evaluation of case management activities to ensure individualized care for members. * Clinical Expertise: Applies clinical judgment and expertise to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care, utilizing evidence-based criteria and practicing within the scope of licensure. * Collaboration and Consultation: Collaborates with physician advisors, internal departments, and external customers to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions. * Communication and Documentation: Responds to members, providers, and regulatory organizations in a professional manner, protecting confidentiality, and provides consistent and accurate documentation. * Quality Improvement: Participates in quality improvement efforts, recommending changes and implementing solutions to improve member outcomes and care. * Resource Management: Coordinates and secures resources, integrating and modifying them as needed to meet member needs and achieve desired outcomes. * Prioritization and Organization: Plans, organizes, and prioritizes assignments to comply with performance standards, corporate goals, and established timelines, ensuring efficient and effective case management. #LI-Remote The expected hiring range for a Care Management Nurse 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 $33.80 - $55.00 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 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 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 [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.