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Cambia Health SolutionsCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical care management, including case management and disease management, while ensuring compliance with medical policies and standards of care. Possesses strong communication, organization, and critical thinking skills to effectively collaborate with healthcare teams and manage member needs.
Highest-signal resume keywords
Case Management ExperienceClinical Care ManagementLicensure in NursingStrong Communication SkillsCritical Thinking Skills
About the role
Key responsibilities & impact- Provide clinical care management, including case management, disease management, and/or care coordination
- Perform assessment, planning, implementation, coordination, monitoring, and evaluation to identify member needs and measure outcomes
- Apply clinical expertise and evidence-based criteria to ensure compliance with medical policy, medical necessity guidelines, and standards of care
- Practice within license scope
- Consult with physician advisors on clinically appropriate determinations
- Serve as a resource to internal and external customers
- Collaborate with departments to resolve claims, quality of care, and member or provider issues
- Identify problems or needed changes and recommend resolutions
- Participate in quality improvement efforts
- Respond professionally in writing or by phone to members, providers, and regulatory organizations
- Protect confidentiality of sensitive documents and issues
- Maintain consistent and accurate documentation
- Plan, organize, and prioritize assignments to meet performance standards, corporate goals, and timelines
Requirements
What you’ll need- Associate or Bachelor's Degree in Nursing or related field, or equivalent combination of education and experience
- 3 years of case management, utilization management, disease management, or behavioral health case management experience
- Licensure or certification in a state or territory of the United States in a health or human services discipline allowing independent assessments within scope of practice
- At least 3 years (or full-time equivalent) of direct clinical care
- At least one of: URAC-approved case manager certification; Bachelor's degree or higher in a health or human services-related field; or current unrestricted RN license for medical care management
- Psychiatric RN or Master's degree in Behavioral Health preferred for behavioral health care management
- Knowledge of health insurance industry trends, technology, and contractual arrangements
- General computer skills, including Microsoft Office, Outlook, and internet search
- Familiarity with health care documentation systems
- Strong oral, written, interpersonal communication, and customer service skills
- Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively
- Strong organization and time management skills with ability to manage workload independently
- Critical thinking and decision-making skills
- Experience with AI tools and technologies highly desired
- Wired internet connection; satellite or cellular internet is not accepted
- Minimum internet speeds of 5Mb upload and 10Mb download
- Access to a personal mobile device for MFA
- Successful background check
Benefits
Comp & perks- 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 varying by role and tenure
- 10 company-paid holidays
- Market-leading 401(k) with significant company match
- Potential discretionary retirement contribution based on company performance, with no vesting period
- Bonus opportunities
- Up to 12 weeks of paid parental time off after 12 months of continuous service
- Award-winning wellness programs that reward participation
- Employee Assistance Fund
- Commute and parking benefits
- Work from home options for most roles
- Employee resource groups
- Cambia-supported community outreach programs
- Personal mobile device required for MFA setup
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Care ManagementCase ManagementDisease ManagementUtilization ManagementBehavioral Health Case ManagementAssessment and PlanningMonitoring and EvaluationDocumentation SkillsDecision-Making SkillsCompliance with Medical Policies
Soft Skills
Interpersonal CommunicationCustomer Service SkillsOrganization SkillsTime Management SkillsProblem-Solving Skills
Tools & Technologies
Microsoft OfficeOutlookHealth Care Documentation SystemsAI Tools and Technologies
Certifications & Qualifications
URAC-Approved Case Manager CertificationRN LicenseMaster's Degree in Behavioral Health
Industry Keywords
Health Insurance Industry TrendsMedical Necessity GuidelinesQuality Improvement EffortsConfidentiality StandardsRegulatory Compliance