Care Manager RN - UM (Full-Time) Weekends (Remote)

TL;DR

Care Manager RN - UM (Full-Time) Weekends (Remote) (Utilization Management): Reviewing healthcare services, applying medical criteria, and coordinating care management interventions with an accent on utilization review, quality improvement, and member outcomes. Focus on analyzing clinical data, resolving care quality issues, educating providers and members, and identifying opportunities for health coaching and case management.

Location: Remote from Pennsylvania, United States; weekend availability on Saturday and Sunday plus three weekdays is required.

Company

hirify.global provides health insurance and healthcare services.

What you will do

• Implement utilization and care management reviews using approved clinical criteria, medical policies, and industry standards.
• Monitor healthcare service delivery and identify opportunities to improve quality, efficiency, and member outcomes.
• Refer members to health coaching and case management interventions when appropriate.
• Educate providers, facilities, vendors, and members while supporting effective care coordination.
• Analyze outcomes data, develop action plans, and improve ongoing care management services.
• Maintain compliant documentation and protect member privacy in accordance with HIPAA and applicable laws.

Requirements

• Current Pennsylvania RN licensure or multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) is required.
• At least three years of related progressive clinical experience, including experience in a clinical setting.
• Ability to analyze data, measure outcomes, prioritize work, and meet deadlines in a fast-paced environment.
• Strong written and verbal communication, analytical, organizational, computer, and software skills.
• Availability to work Saturdays and Sundays in addition to three weekdays.
• Ability to comply with applicable healthcare regulations, corporate policies, HIPAA, and information security requirements.

Nice to have

• Bachelor’s degree in Nursing.
• RN case management or care management experience.
• Experience in utilization management, quality assurance, managed care, acute inpatient, post-acute, skilled nursing, or inpatient rehabilitation settings.
• Certification in utilization management or a related field.

Culture & Benefits

• Full-time remote work arrangement.
• Weekend schedule combined with three weekday shifts.
• Travel requirement of 0%–25%.
• Work focused on quality, efficiency, collaboration, privacy, and improved healthcare outcomes.