Nurse Case Manager II (Remote – Georgia or Compact States)
Location: Fully Remote (EST Time Zone Required)
Schedule: Monday–Friday, 8 AM–5 PM EST
Job SummaryThe Nurse Case Manager II is responsible for delivering comprehensive case management services to support members in achieving improved health outcomes. This role involves assessment, care planning, coordination, and advocacy to ensure quality, cost-effective care aligned with an individual’s benefit plan.
This is a fully remote role requiring a compact, unrestricted RN license and prior remote work experience.
Key ResponsibilitiesConduct comprehensive assessments of members’ clinical needs and benefit eligibility.
Develop and implement individualized case management plans.
Utilize clinical guidelines, internal systems, and available resources to drive optimal care outcomes.
Coordinate with internal teams, providers, and external agencies to support care continuity.
Document all case activity in compliance with regulatory, accreditation, and organizational policies.
Communicate effectively with members, caregivers, and health partners.
Manage multiple cases simultaneously in a fast-paced environment.
Maintain confidentiality and adhere to HIPAA regulations, working from a private office space.
Required QualificationsActive, unrestricted Compact RN License (RN must reside in a compact state; EST-time-zone residency required).
2–3 years clinical experience in hospital, home health, ambulatory care, or similar setting.
2+ years managed care and/or healthcare industry experience.
Case Management experience (required).
Previous remote work experience (required).
Strong computer proficiency (navigating multiple systems).
Excellent verbal/written communication skills.
Ability to multitask, prioritize, and work independently.
High School Diploma or GED (verified).