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? Work Location: Remote Apply tot his job Apply To this Job