Nurse Case Manager II

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