USRN Case Manager – Utilization Management

Role Overview

• Assess, plan, coordinate, and monitor patient care
• Collaborate with physicians, interdisciplinary teams, patients, and families
• Develop individualized care plans
• Facilitate care across the continuum
• Ensure compliance with HIPAA, regulatory standards, and internal policies

Requirements

• Active US Registered Nurse (RN) license
• Experience in case management, utilization review, or managed care preferred
• Strong understanding of managed care principles and healthcare systems
• Familiarity with clinical guidelines such as InterQual, Milliman, or similar is an advantage
• Excellent communication, coordination, and documentation skills
• Strong organizational skills with the ability to manage multiple cases
• Proficiency in Microsoft Office and clinical documentation systems

Benefits

• Remote work flexibility
• Collaborate with an international team