Job Description

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Job Title: Nurse Case Manager

Location: REMOTE

Duration: 8+ Months (Potential for Extension)

Pay Rate: $39.84/HR on W2

Schedule: Monday-Friday 8-5pm EST

Please add city and state the candidate resides in at top of resume- candidate must reside in an EST time zone and must work EST hours. This is a fully remote role WFH position.

Put on Resume

• Registered Nurse with active license in good standing within the region where jub duties are performed is required.
• Must be licensed in the state of PA or must have a compact license in the state they reside

Set Class Start date of 10/12/26 - if the candidate does not clear to start by 10/12/26, then they will need to start on 11/9/26

The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license

Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Duties :
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services
Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate
administration of benefits
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Experience :
3 years Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
Healthcare and/or managed care industry experience.
Case Management experience preferred-- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Typical office working environment with productivity and quality expectations

Education:
RN with current unrestricted state licensure in Pennsylvania or a compact state.
Associate's of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED)
Bachelor's of Science in Nursing (BSN) (PREFERRED)
Case Management Certification CCM preferred

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