Case Manager, Registered Nurse (Remote)

Position Summary

The Nurse Case Manager is responsible for delivering comprehensive case management services through telephonic and/or face-to-face interactions. This role involves assessing, planning, implementing, and coordinating care strategies to support members' medical needs and promote overall wellness. This role operates within established regulatory and organizational policies, applying case management processes and service strategies that align with network management and clinical coverage guidelines. Strong interviewing and engagement skills are critical to understanding member needs and facilitating smooth transitions to appropriate programs and services.

What you will do

• Utilize clinical judgment and data-driven tools to evaluate member eligibility, identify health risks, and develop proactive care plans that address both short- and long-term health outcomes.
• Conduct holistic assessments that consider co-morbid conditions, functional limitations, and social determinants of health.
• Review prior claims, evaluate work capacity, and determine the need for referrals to clinical resources.
• Collaborate with supervisors and multidisciplinary teams is essential to overcome barriers and optimize care planning.

Required Qualifications

• An active and unrestricted RN license in the state of residence.
• Willing and able to obtain additional state licenses upon hire. (Paid for by the company)
• 3+ years' experience of acute care and/or case management.
• 2+ years' Med/Surg experience.
• Must be willing to work Monday-Friday 8:00am-4:30pm local time zone.

Preferred Qualifications

• Prefer candidate in PST Zone.
• Behavioral Health experience.
• Certified Case Manager.
• Managed care experience.
• Strong telephonic communication skills.
• Ability to manage multiple priorities, effective organizational, and time management skills.
• Ability use a computer station and sit for extended periods of time.

Education and Licensing

• Associate's Degree in Nursing.
• RN License in your state of residence.

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range

The typical pay range for this role is

$60,522.00 - $129,615.00