Integrated Care Management Nurse or Clinician

Remote in ID, WA, UT, OR. Candidates outside of these states will not be considered.

Primary Job Purpose

The Integrated Care Management Nurse or Clinician provides clinical, value-based patient-centered care management to best meet the member’s specific healthcare needs while improving the health of the member and cost of care . Supports individuals, and families as needed, with multiple complex health conditions by systematically identifying and removing clinical and non-clinical barriers which lead to poor health outcomes.

General Functions and Outcomes

• Support members via an intensive, interdisciplinary relationship-based Clinician led case manager model with low ratios to improve clinical outcomes and reduce total cost of care.

• Drive member behavior change, health coach/lifestyle modification, social determinants of health remediation, intensive coordinated transitions of care, engagement of family members, and direct collaborative provider engagement.

• Serve as the individual’s single point of contact with no (or few) handoff’s to other disciplines.

• Assesses four potential problem domains including medical, behavioral, social and health system using a holistic approach.

• Identify an individual’s barriers to health improvement and compliance by utilizing a narrative relationship-based approach to assessing health complexity.

• Leverage the individual’s motivation for change and create prioritized interventions based on the individual’s goals.

• Utilize Triple Aim framework.

• Establishing and measuring outcomes based on care plan goals as well as clinical, functional, economic and quality of life outcomes.

• Responsible for essential activities of case management including assessment, planning, implementation, coordination, monitoring, and evaluation.

• Consults with physician advisors to ensure clinically appropriate determinations.

• Serves as a resource to internal and external customers.

• Collaborates with other departments to resolve claims, quality of care, member or provider issues.

• Identifies problems or needed changes, recommends resolution, and participates in quality improvement efforts.

• Responds in writing or by phone to members, providers and regulatory organizations in a professional manner while protecting confidentiality of sensitive documents and issues.

• Provides consistent and accurate documentation.

• Plans, organizes and prioritizes assignments to comply with performance standards, corporate goals, and established timelines.

Minimum Requirements

• 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 clinical 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.

• Patient focused approach to problem solving, such as looking for opportunities to help each member achieve optimal health outcomes.

• Strong customer service skills including listening, patience, empathy, maintaining confidentiality and focus on meeting customer needs.

Normally to be proficient in the competencies listed above

The Integrated Care Management Nurse or Clinician would have a Bachelor’s Degree in Nursing or Master’s degree in a behavioral health related field and 3 years of case management, utilization management, disease management, or behavioral health case management experience or equivalent combination of education and experience. Experience working in an Integrated Behavioral Health-Medical model preferred.

Required Licenses, Certifications, Registration, Etc.

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. Certification as a case manager from the URAC-approved list of certifications is preferred.

Must have at least one of the following:

• Master’s degree in Behavioral Health related field with a current, unrestricted independent clinical license (ex. LCSW) or

• Registered nurse (RN) license (must have a current unrestricted RN license), BSN strongly preferred.

#LI-Remote

The expected hiring range for an Integrated Care Management Nurse or Clinician is $40.00 - $42.00 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 $32.93 - $53.85 an hour.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

• medical, dental, and vision coverage for employees and their eligible family members

• annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)

• paid time off varying by role and tenure in addition to 10 company holidays

• up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)

• up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)

• one-time furniture and equipment allowance for employees working from home

• up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.