Nurse Case Manager (Remote)

Job Title: Remote RN Case Manager (EST Time Zone)
Job Type: Full-Time, Remote
Schedule: Monday–Friday, 8:00 AM – 5:00 PM EST
Training Duration: 4–6 weeks

Position Summary:

The Case Manager will utilize a collaborative process of assessment, planning, facilitation, and advocacy to coordinate services and resources that meet an individual’s health needs and benefit plan. The goal is to promote optimal, cost-effective outcomes in a fully remote work setting.

Location Requirements:

• Candidate must reside in the EST time zone.

• If residing in North Carolina (NC): Must have an unrestricted active RN license in NC.

• If residing outside of NC: Must hold an active compact RN license.

• Candidate’s location must be included at the top of the resume.

Key Responsibilities:

• Conduct comprehensive assessments to determine members' eligibility, needs, and care options.

• Apply clinical guidelines and benefit criteria to develop case management plans.

• Collaborate with members, families, healthcare providers, and community resources to coordinate care.

• Document case activity accurately and in a timely manner in internal systems.

• Ensure compliance with company policies, regulatory standards, and accreditation requirements.

• Use multiple systems and tools for case documentation and resource coordination.

Required Qualifications:

• Active, unrestricted Registered Nurse (RN) license as outlined above.

• Minimum 2–3 years of clinical experience in hospital, home health, or ambulatory care settings.

• Minimum 2 years of healthcare and/or managed care industry experience.

• Case Management experience is required.

• Strong computer literacy with the ability to navigate multiple systems simultaneously.

• Excellent verbal and written communication skills.

• Ability to multitask and work effectively in a dynamic, fast-paced environment.

Preferred Qualifications:

• Case Management Certification (e.g., CCM) is preferred.

Work Environment:

• Sedentary work involving extended periods of sitting, telephone communication, and computer use.

• Must be comfortable performing close inspection of electronic and written documentation.

• Productivity and quality expectations are applicable as per performance standards.