RN Case Manager/Utilization Review

Location: Remote | 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?

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