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Insurance Nurse Case Manager Jobs in Puerto Rico

NeoMed Center Inc

PR · On-site

$20.72 - $22.88/hr

  • Dental

  • Retirement

Enfermero/a Generalista Ubicación: Trujillo Alto, PR Unidad: Cuidados Primarios-Ambulatorios y Sala de Emergencias Clasificación: No Exento/a Rango salarial: $20.72 a $22.88 por hora Jornada:

Encompass Health

Rehab Liaison

San Juan, PR · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

You will develop and maintain excellent relationships with all stakeholders including prospective patients, family members, physicians, ICU and floor nurses, discharge planners, case managers and ...

Headlands Research

Clinical Research Nurse, RN

San Juan, PR

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Clinical Research Nurse (RN) Location: San Juan, PR | Site Name: CMR Center | Full-Time Are you an ... Manager Benefits: Our benefits package for full-time employees includes health insurance (medical ...

Insight Communications

PR · On-site

Also, provide the necessary feedback if in the case of emergent patient care situations, by seeking ... Knowledgeable and able to effectively manage the Remote Patient Monitoring platform system

Insight Communications

PR · On-site

Also, provide the necessary feedback if in the case of emergent patient care situations, by seeking ... Knowledgeable and able to effectively manage the Remote Patient Monitoring platform system

Insight Communications

PR · On-site

Also, provide the necessary feedback if in the case of emergent patient care situations, by seeking ... Knowledgeable and able to effectively manage the Remote Patient Monitoring platform system

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All JobsInsurance Nurse Case JobsInsurance Nurse Case Manager JobsInsurance Nurse Case Manager Jobs in Puerto Rico

Insurance Nurse Case Manager information

How does an insurance nurse case manager typically collaborate with claims adjusters and other healthcare professionals?

Insurance Nurse Case Managers work closely with claims adjusters to review medical documentation, assess treatment plans, and ensure that patients receive appropriate care while managing costs. They frequently communicate with healthcare providers, such as physicians and therapists, to coordinate care and gather information critical to case decisions. This collaborative approach helps streamline claims processing and supports positive patient outcomes, making effective communication and teamwork essential skills for success in this role.

What is the difference between Insurance Nurse Case Manager vs Claims Nurse?

AspectInsurance Nurse Case ManagerClaims Nurse
CredentialsRN license, case management certification often preferredRN license, claims processing training
Work EnvironmentHealthcare settings, insurance companies, case management teamsInsurance companies, claims departments, healthcare providers
Employer & IndustryInsurance carriers, healthcare organizationsInsurance carriers, third-party claims organizations

The Insurance Nurse Case Manager and Claims Nurse roles both require RN licensure and involve working within insurance and healthcare settings. However, the Insurance Nurse Case Manager focuses on coordinating patient care and managing case progress, while the Claims Nurse primarily reviews and processes insurance claims. Both roles are essential in the insurance industry, but they differ in daily responsibilities and focus areas.

What are the key skills and qualifications needed to thrive as an insurance nurse case manager, and why are they important?

To thrive as an Insurance Nurse Case Manager, you need a registered nursing license, strong clinical assessment skills, and experience in case management or utilization review. Familiarity with case management software, health insurance systems, and certifications such as CCM (Certified Case Manager) are typically required. Exceptional communication, organizational skills, and the ability to advocate for patients while balancing payer requirements are key soft skills in this role. These skills ensure effective coordination of patient care, cost management, and positive outcomes for both patients and insurance providers.

What is an insurance nurse case manager?

Insurance Nurse Case Managers are registered nurses who work for insurance companies or third-party administrators to help manage and coordinate patient care. They assess patients' medical needs, develop care plans, and act as a liaison between patients, healthcare providers, and insurers. Their primary goal is to ensure that patients receive appropriate, cost-effective care while facilitating communication and helping with claims processes. Insurance Nurse Case Managers also provide education and support to patients and families throughout the treatment process.

What are popular job titles related to Insurance Nurse Case Manager jobs in Puerto Rico?

For Insurance Nurse Case Manager jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Insurance Nurse Case Manager jobs in Puerto Rico look for?

The top searched job categories for Insurance Nurse Case Manager jobs in Puerto Rico are:

What cities in Puerto Rico are hiring for Insurance Nurse Case Manager jobs?

Cities in Puerto Rico with the most Insurance Nurse Case Manager job openings:

Insurance Nurse Case Manager jobs near you
Infographic showing various Insurance Nurse Case Manager job openings in Puerto Rico as of August 2026, with employment types broken down into 1% As Needed, 74% Full Time, 19% Part Time, 2% Temporary, and 4% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution.

Enfermero(a) Graduado(a) - (Perdiem)

San Juan Capestrano

San Juan, PR

Full-time

Posted 20 days ago

Job description

Responsibilities

REGISTERED NURSE ESSENTIAL FUNCTIONS

  • Provide and coordinate care by assessing patients' physical and behavioral health needs.
  • Develop and implement nursing care plans.
  • Maintain medical records and educate patients and their families about various physical and behavioral health conditions.
  • Provide nursing care and services within the standards and scope of nursing practice as defined within the state Nurse Practice Act regulations, policies, procedures, and protocols, as well as facility and corporate policies and procedures.
  • Ensure physicians' orders are legible if taken verbally and transcribed appropriately per policy and procedure.
  • Ensure patients' status is assessed on an ongoing basis and pertinent information is gathered and documented.
  • Notify physicians of significant changes in status such as difficulties with detox, medical emergency, change in medical status regarding response to medications, and related challenges.
  • Ensure that initial nursing treatment plans are completed upon admission and that all nursing treatment plans are specific to assessed needs.
  • Demonstrate knowledge and utilization of universal precautions in providing direct patient care.
  • Accurately administer medications per ordered note.
  • Document accurate count of controlled substance medication administration on required documents.
  • Complete admission and discharge processing efficiently and accurately as directed.
  • Exhibit therapeutic rapport with patients by maintaining professional boundaries, respecting personal space, giving patients direct attention, and maintaining rational detachment.
  • Provide direction or coordinate the activities of the unit as directed.
  • Communicate therapeutically and professionally with patients, visitors, co-workers, and others involved inpatient treatment.
Qualifications

EDUCATION/LICENSURE/EXPERIENCE/SKILL REQUIREMENTS

  • Must have graduated from an accredited school of nursing.
  • Must possess a current Registered Nurse (RN) license as required by the state of employment or be eligible to practice nursing in accordance with state requirements
  • One year of nursing experience; previous psychiatric, mental, behavioral, or substance use nursing experience a plus
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).
  • First aid may be required based on state or facility requirements.

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Employment Type: OTHER

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