Utilization Management Nurse

Utilization Management Nurse

Portland, OR; Lewiston, ID: Burlington, WA and Salt Lake City, UT

This position will work in an office environment in one of the above locations.

Responsibilities & Requirements:

Be part of a team that will help us build a new approach to care management. These positions will be a key part of a multi-disciplinary care team working in partnership with providers to improve the quality of care our members receive.

Minimum Requirement:

• 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 verbal, written and interpersonal communication and customer service skills.
  
• Ability to interpret policies and procedures and communicate complex topics effectively
  
• Experience in one of the specialties preferred; Long Term Acute Care (LTAC), Skilled Nursing Facility (SNF) or In-Rehabilitation (IPR)patient

Normally to be proficient in the competencies listed above:

• Utilization Management Clinician would have a/an Associate or Bachelor’s Degree in Nursing. 3 years of case management, utilization management, disease management, auditing or retrospective review experience or equivalent combination of education and experience.
  

Required Licenses, Certifications, Registration, Etc.:

• Registered nurse (RN) license (must have a current unrestricted RN license for medical care management)
  

About Us:
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity 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 drug screen and background check is required.

Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We’ve been here for members more than 90 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association. If you’re seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers’ engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia’s portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.