Location:

In office OR Hybrid (Hybrid will only apply in cases where applicant lives more than an hour from the office. All training will occur in office.|

Job Type:

Full-Time Join a mission-driven team that's redefining healthcare support. Corporate Care Management is seeking an experienced and compassionate Registered Nurse (RN) to join our team in a dual telephonic role specializing in Case Management and Utilization Review. This position is ideal for a clinically skilled RN who thrives in a fast-paced, remote work environment and is committed to delivering high-quality, cost-effective patient care. About the Role As a Remote RN in this role, you'll be instrumental in reviewing treatment plans, evaluating medical necessity, developing patient-centered care plans, and coordinating with healthcare providers and insurance partners to ensure optimal outcomes. You'll help bridge the gap between patients and providers while supporting self-funded insurance models with thoughtful, data-driven care decisions.

Key Responsibilities Chronic & Complex Case Management :

Conduct comprehensive assessments and develop individualized care plans for patients with chronic or complex conditions.

Care Coordination :

Collaborate with patients, families, and providers to ensure efficient care transitions and reduce unnecessary healthcare costs.

Utilization Review :

Evaluate medical necessity and appropriateness of care across inpatient, outpatient, and home settings.

Appeals & Denials Support :

Assist in preparing appeal documentation for denied claims and advocate for medically necessary services.

Provider Negotiation :

Coordinate single-case agreements and out-of-network arrangements as needed.

Documentation :

Maintain detailed and compliant patient records, care plans, and communications.

Patient Advocacy & Education :

Empower patients and families by providing education on diagnoses, treatment options, and care pathways.

Compliance :

Ensure adherence to regulatory requirements, HIPAA standards, and organizational protocols. What You Bring Active, unrestricted Compact RN license (Candidates must reside in a compact state; single-state licenses will not be accepted.) Minimum of 2 years of clinical RN experience Prior experience in Utilization Review and/or Case Management strongly preferred Exceptional communication skills, both verbal and written, with the ability to interact professionally with clinical and non-clinical stakeholders Strong clinical judgment and ability to assess and coordinate complex care needs Proficient in care management platforms, EHR systems, and the Microsoft Office Suite High-speed internet with a minimum of 100 Mbps download / 20 Mbps upload Ability to work independently in a structured remote environment Dedicated home workspace that is private, secure, and free of distractions or unauthorized access to confidential information (HIPAA compliance required) Must successfully complete a criminal background check, license verification, and pre-employment drug screen Remote Work Requirements This is a fully remote position that involves the handling of sensitive, private medical information. To maintain compliance and ensure patient confidentiality, candidates must have a dedicated home workspace that: Is private, secure, and free from distractions Prevents others from overhearing calls or accessing PHI Is equipped with reliable internet and meets basic technical standards

Job Type:

Full-time Pay:

$34.00 - $41.00 per hour

Benefits:

401(k) Dental insurance Health insurance Paid sick time Paid time off Vision insurance Application Question(s): What makes you interested in this role with Corporate Care Managment What attracts you to this role in Case Managment/Utilization review Do you have a active RN License? How many years of professional nursing experience do you have? Do you have a compact RN license? Do you have a private, secure workspace in your home to perform remote work?

Work Location:

In person