We are seeking an experienced Nurse Case Manager II to provide comprehensive clinical case management services in a fully remote environment. The Nurse Case Manager will utilize clinical expertise, assessment, care coordination, advocacy, and available healthcare resources to support members in achieving optimal health outcomes while ensuring appropriate, cost-effective utilization of benefits and services.
The ideal candidate will have strong RN clinical experience, case management/care coordination experience, and healthcare or managed care experience. Experience working with complex or chronic patient populations is highly valued.
Conduct comprehensive assessments of referred members to identify clinical, social, and healthcare needs.
Evaluate member needs, eligibility, benefit plans, and available internal and external programs and services.
Develop and coordinate individualized case management plans based on member needs.
Facilitate access to appropriate healthcare services, community resources, and support programs.
Collaborate with members, providers, healthcare professionals, and other internal and external stakeholders.
Monitor member progress and modify case management approaches as appropriate.
Apply established clinical criteria, case management guidelines, policies, procedures, and regulatory standards.
Support appropriate administration of member benefits while promoting quality and cost-effective outcomes.
Identify barriers to care and advocate for appropriate services and resources.
Maintain accurate and timely clinical documentation.
Utilize clinical tools and available data to support assessment, decision-making, and case resolution.
Work collaboratively with interdisciplinary teams to support continuity of care and improved health outcomes.
Perform all responsibilities in accordance with applicable regulatory, accreditation, and company requirements.
| Location | (Remote) |
| Job Type | Contractor |
| Salary | $42–$43.11 Per Hour |
Active, unrestricted Registered Nurse (RN) license in good standing.
Must hold an active Pennsylvania RN license OR a multistate/compact RN license in the state of residence.
Candidate must reside in an Eastern Time Zone state and be able to work EST hours.
Minimum 3 years of clinical nursing experience required.
Clinical experience in a hospital, home health, ambulatory care, or similar healthcare setting.
Healthcare and/or managed care industry experience required.
Strong clinical assessment and care coordination skills.
Excellent written and verbal communication skills.
Strong organizational skills and attention to detail.
Ability to work independently in a fully remote environment.
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