Job Description

Job Summary
Seeking a Remote Registered Nurse Case Manager to support clinical operations through a collaborative process of assessment, planning, facilitation, and advocacy. The RN Case Manager will coordinate services and support for members based on their benefit plans and healthcare needs to promote optimal and cost-effective outcomes. This position requires strong case management experience and active nursing licensure.
Key Responsibilities
Conduct comprehensive assessments of members’ health needs and eligibility
Develop individualized care plans and coordinate services
Apply and interpret clinical guidelines, standardized case management plans, and benefit criteria
Evaluate internal and external resources for best care solutions
Ensure compliance with regulatory standards, policies, and procedures
Facilitate communication between members, families, providers, and other care team members
Use clinical tools and data to drive case management decisions
Promote quality, cost-effective outcomes through proactive case interventions
Required Qualifications
Minimum of 1–2 years of Case Management experience
Strong assessment, planning, and communication skills
Ability to work independently in a remote setting
Must reside in an EST time zone
Preferred Qualifications
Experience working in health plan or managed care environment
Certifications
Active, unrestricted RN license in Florida required
– If not residing in Florida, a valid compact RN license is required
Case Management certification preferred
COVID-19 vaccination may be required per company policy

Job Tags

Remote work,

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