Case Manager Nurse RN

TL;DR

Case Manager Nurse RN (Health): Provide telephonic case management for health insurance plan participants, conducting assessments and developing treatment plans with an accent on cost-effective, high-quality care coordination. Focus on monitoring interventions, advocating for patients, and negotiating cost management strategies while meeting productivity and documentation standards.

Remote, United States. Possession of a current California RN license; a multi-state license will also be required.

Compensation: $36-$38 per hour, depending on location, skills, and experience.

Company

Personalized health platform combining health plan administration, holistic wellbeing solutions, and care navigation to reduce costs and improve health outcomes for employers, health plans, and health systems.

What you will do

• Contact patients to complete thorough assessments of physical, psychosocial, emotional, spiritual, environmental, and financial needs.
• Review claims data to develop clinical pictures and identify program participation.
• Develop and monitor treatment plans in collaboration with patients, families, providers, and multidisciplinary teams.
• Initiate and maintain contact throughout the care continuum, advocating for quality care and cost reduction.
• Perform utilization review, mentor LVNs on clinical issues, and maintain detailed documentation.
• Negotiate cost management strategies and prepare reports on outcomes and cost avoidance.

Requirements

• Graduation from an accredited Registered Nursing (RN) program and possession of a current California RN license (multi-state license also required).
• Minimum of five years medical/surgical or acute care experience, including two years in case management or equivalent.
• Knowledge of medical claims, ICD-10, CPT, HCPCS coding, and ability to critically evaluate claims data.
• Prior case management, emergency room, critical care, or relevant clinical experience.
• Excellent interpersonal, communication, negotiation skills; computer proficiency in Microsoft Office Suite.
• Ability to work independently, meet productivity/quality requirements; may be required to work evening and/or weekend shifts.

Culture & Benefits

• Full benefits package starting day one, including comprehensive medical and dental through our own health solutions.
• Paid Time Off, mental health support, retirement planning, and financial protection.
• Professional development with career progression and learning budgets.
• Mission-driven culture emphasizing diversity, inclusion, and real impact on health.
• Inclusive environment celebrating diverse backgrounds for innovation and collaboration.