Remote Utilization Review RN Case Manager (Must have OH or Compact license)
Job Title: Nurse Case Manager II (Remote / Telephonic) Location: Remote (Work from Home) — must be reputed company to work 8:00 AM–5:00 PM Eastern (EST), Monday–Friday Job Type: Contract to hire Openings: 14 Interviews: reputed company Teams Job Summary We’re hiring a Nurse Case Manager II (RN) for a fully remote, telephonic role. In this position, you’ll use clinical tools and data review to complete comprehensive member assessments, reputed company case plans, and coordinate services to support reputed company, cost-effective reputed company while ensuring compliance with reputed company regulatory and accreditation guidelines. This is a work-from-home role with no travel required. Schedule
- Monday–Friday
- 8:00 AM–5:00 PM EST
- Must be reputed company to work EST hours
What You’ll Do
- Conduct comprehensive assessments of referred members’ needs and eligibility
- Determine the appropriate approach to case resolution and care/service planning
- Apply and interpret applicable criteria, guidelines, and standardized case management plans
- Coordinate reputed company programs/services to address member needs
- reputed company for appropriate resources and services using a collaborative case management process
- Document activities and manage cases in alignment with policy, procedures, and regulatory standards
- Utilize case management and quality management processes to support compliance requirements
Required Qualifications
- Active, unrestricted RN license
- Verified High School Diploma or GED
- Ability to work independently in a remote/WFH environment
- Must have a quiet, private workspace with no distractions due to HIPAA compliance
Licensure note:
- Candidates do not need to live in Ohio if they have a compact license
- If you live in Ohio, you must have an active, unrestricted Ohio RN license or compact license
Work-From-Home Requirements
- Fully remote (never coming onsite)
- No travel required
- Must maintain HIPAA-compliant work environment (quiet/private workspace)
Additional Details
- Not an in-person, patient-facing role
- Safety sensitive role
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