Case Manager Registered Nurse

Position Overview

The Case Manager RN role is 100% remote (work from home) with normal working hours from Monday through Friday, 9:00 AM – 5:30 PM in the candidate's time zone of residence. Occasional evening, weekend, and holiday shifts may be required.

Responsibilities

• Assess, plan, implement, and coordinate case management activities with members to evaluate medical needs and facilitate overall wellness.
• Develop proactive courses of action to address issues and enhance short- and long-term health outcomes.
• Conduct evaluations of member needs and benefit plan eligibility using clinical tools and data review.
• Apply clinical judgment to reduce risk factors, address barriers, and handle complex health and social indicators.
• Review prior claims and assess work capacity, restrictions, and limitations.
• Consult with supervisors and multidisciplinary teams to overcome barriers and manage cases effectively.
• Comply with regulatory and company policies and procedures.

Required Qualifications

• Active RN licensure (any state).
• Willingness to obtain multiple state RN licenses after hire if required (expenses paid by company).
• 2+ years of clinical experience as an RN (e.g., Emergency Department, Home Health, ICU, Med/Surg, etc.).

Preferred Qualifications

• Certified Case Manager (CCM) certification.
• 3+ years of experience with Microsoft Office Suite.
• Case Management experience in an integrated model.
• Discharge Planning experience.
• Managed care experience.
• Bachelor of Science in Nursing (BSN).