Case Management Nurse, Multiple Locations
The Case Manager Nurse plays a critical role in supporting members with complex or chronic conditions by providing proactive, telephonic case management grounded in a whole-person approach. This role focuses on reducing avoidable utilization, improving care coordination, and helping members navigate the healthcare system with confidence and clarity.
As a trusted clinical resource, the Case Manager Nurse partners closely with members, providers, and health plans to assess needs, develop individualized care plans, and advocate for appropriate, cost-effective services. In addition to core case management responsibilities, this role also supports utilization review activities when needed, contributing to timely medical necessity determinations and continuity of care.
This position is ideal for an experienced RN who brings strong clinical judgment, excellent communication skills, and a passion for improving outcomes for high-need populations in a collaborative, remote care management environment.
This is a fully remote role. Candidates must reside in Oregon, Washington, Nevada, or Arizona.
Schedule: Monday–Friday | 8:00 AM–5:00 PM Pacific Time
What You'll Do
Patient Identification & Assessment
• Identify members who would benefit from case management using claims data, referrals, and clinical records
• Review referrals for clinical appropriateness using sound judgment and program parameters
• Conduct comprehensive assessments of medical, behavioral, and social needs using a whole-person approach
Care Planning & Coordination
• Develop individualized care plans based on patient needs, barriers, and goals
• Coordinate care across the continuum, including primary care, specialists, behavioral health, and community-based resources
• Facilitate clear communication between patients, providers, caregivers, and health plans to support safe transitions of care and adherence to treatment plans
Clinical Case Management & Advocacy
• Provide telephonic case management for high-utilization patients with complex or chronic conditions
• Use best practices in chronic disease management, motivational interviewing, and patient education
• Advocate for timely, appropriate, and cost-effective care while balancing clinical judgment with plan guidelines
• Support patients in navigating healthcare systems and overcoming barriers to care
Utilization Review & Medical Decision-Making
Evaluate precertification requests using evidence-based criteria and plan-specific guidelines
• Review ongoing inpatient stays and make length-of-stay determinations as appropriate
• Partner with Appeals & Denials and/or in-house providers to support complex clinical decisions
Documentation, Reporting & Compliance
• Document all assessments, interventions, communications, and determinations thoroughly and accurately in ICM systems
• Provide client-facing reports summarizing interventions, outcomes, and estimated cost savings
• Ensure compliance with internal policies, regulatory requirements, and HIPAA standards
Collaboration, Leadership & Continuous Improvement
• Partner with other clinical teams across ICM to remove care barriers and improve patient outcomes
• Serve as a senior clinical resource, contributing to program development, cross-training, and process improvement
• Stay current on best practices, regulations, and clinical guidelines related to case management
• Participate in training, quality assurance initiatives, and professional development
What You Bring
Required
• Active, unrestricted Registered Nurse (RN) license in good standing
• Associate’s or Bachelor’s degree in Nursing
• 5+ years of clinical nursing experience
• Strong knowledge of chronic disease management, utilization management, and social determinants of health
• Experience managing complex, high-utilization patient populations
• Excellent written and verbal communication skills with empathy, professionalism, and emotional intelligence
• Strong organizational skills with the ability to manage multiple priorities independently
• Sound clinical judgment and confidence navigating complex or sensitive situations
• Comfort working independently in a remote environment with strong accountability and follow-through
• Ability to manage confidential information in compliance with HIPAA
Even Better If You Have
• Experience in case management, care coordination, or discharge planning
• Experience in a TPA or self-funded health plan environment
• Knowledge of health insurance regulations and utilization management processes
• Experience using medical necessity criteria and utilization review tools
• Experience with EMRs and care management platforms
• Mental health and/or substance use disorder (MH/SUD) case management experience
• Multi-state licensure
• Case management or utilization certifications (e.g., CCM, CPUR, CPHM)
About Innovative Care Management
In an increasingly complex healthcare environment, ICM remains focused on something essential: putting people at the center of every decision. We are dedicated to ensuring that members and health plans feel genuinely seen, heard, and supported throughout their care journey.
We serve clients nationwide with a values-driven approach that blends compassion, clinical expertise, and operational excellence. Our core values: Kindness, Personal Responsibility, a Can-Do Attitude, and Humble Confidence, shape how we work, how we lead, and how we care for those we serve.
As we grow, we welcome individuals who share our belief that healthcare should be effective, compassionate, and truly centered on people.
Apply tot his job
Apply To this Job
As a trusted clinical resource, the Case Manager Nurse partners closely with members, providers, and health plans to assess needs, develop individualized care plans, and advocate for appropriate, cost-effective services. In addition to core case management responsibilities, this role also supports utilization review activities when needed, contributing to timely medical necessity determinations and continuity of care.
This position is ideal for an experienced RN who brings strong clinical judgment, excellent communication skills, and a passion for improving outcomes for high-need populations in a collaborative, remote care management environment.
This is a fully remote role. Candidates must reside in Oregon, Washington, Nevada, or Arizona.
Schedule: Monday–Friday | 8:00 AM–5:00 PM Pacific Time
What You'll Do
Patient Identification & Assessment
• Identify members who would benefit from case management using claims data, referrals, and clinical records
• Review referrals for clinical appropriateness using sound judgment and program parameters
• Conduct comprehensive assessments of medical, behavioral, and social needs using a whole-person approach
Care Planning & Coordination
• Develop individualized care plans based on patient needs, barriers, and goals
• Coordinate care across the continuum, including primary care, specialists, behavioral health, and community-based resources
• Facilitate clear communication between patients, providers, caregivers, and health plans to support safe transitions of care and adherence to treatment plans
Clinical Case Management & Advocacy
• Provide telephonic case management for high-utilization patients with complex or chronic conditions
• Use best practices in chronic disease management, motivational interviewing, and patient education
• Advocate for timely, appropriate, and cost-effective care while balancing clinical judgment with plan guidelines
• Support patients in navigating healthcare systems and overcoming barriers to care
Utilization Review & Medical Decision-Making
Evaluate precertification requests using evidence-based criteria and plan-specific guidelines
• Review ongoing inpatient stays and make length-of-stay determinations as appropriate
• Partner with Appeals & Denials and/or in-house providers to support complex clinical decisions
Documentation, Reporting & Compliance
• Document all assessments, interventions, communications, and determinations thoroughly and accurately in ICM systems
• Provide client-facing reports summarizing interventions, outcomes, and estimated cost savings
• Ensure compliance with internal policies, regulatory requirements, and HIPAA standards
Collaboration, Leadership & Continuous Improvement
• Partner with other clinical teams across ICM to remove care barriers and improve patient outcomes
• Serve as a senior clinical resource, contributing to program development, cross-training, and process improvement
• Stay current on best practices, regulations, and clinical guidelines related to case management
• Participate in training, quality assurance initiatives, and professional development
What You Bring
Required
• Active, unrestricted Registered Nurse (RN) license in good standing
• Associate’s or Bachelor’s degree in Nursing
• 5+ years of clinical nursing experience
• Strong knowledge of chronic disease management, utilization management, and social determinants of health
• Experience managing complex, high-utilization patient populations
• Excellent written and verbal communication skills with empathy, professionalism, and emotional intelligence
• Strong organizational skills with the ability to manage multiple priorities independently
• Sound clinical judgment and confidence navigating complex or sensitive situations
• Comfort working independently in a remote environment with strong accountability and follow-through
• Ability to manage confidential information in compliance with HIPAA
Even Better If You Have
• Experience in case management, care coordination, or discharge planning
• Experience in a TPA or self-funded health plan environment
• Knowledge of health insurance regulations and utilization management processes
• Experience using medical necessity criteria and utilization review tools
• Experience with EMRs and care management platforms
• Mental health and/or substance use disorder (MH/SUD) case management experience
• Multi-state licensure
• Case management or utilization certifications (e.g., CCM, CPUR, CPHM)
About Innovative Care Management
In an increasingly complex healthcare environment, ICM remains focused on something essential: putting people at the center of every decision. We are dedicated to ensuring that members and health plans feel genuinely seen, heard, and supported throughout their care journey.
We serve clients nationwide with a values-driven approach that blends compassion, clinical expertise, and operational excellence. Our core values: Kindness, Personal Responsibility, a Can-Do Attitude, and Humble Confidence, shape how we work, how we lead, and how we care for those we serve.
As we grow, we welcome individuals who share our belief that healthcare should be effective, compassionate, and truly centered on people.
Apply tot his job
Apply To this Job