Job Description

Job Title: Care Manager RN
Location: Remote United States (Excluding California)
Duration: 6 Months (Possible Extension/Conversion)
Shift: 9:30 AM 6:00 PM EST
Pay Rate: $38.00 - $42.00 Per hr. on w2.

Overview

• We are seeking an experienced Care Manager RN to support care management initiatives within a managed care environment. This role focuses on coordinating care, improving member outcomes, and supporting specialty pharmacy operations, primarily through telephonic outreach.
• The ideal candidate will have strong experience in case management, utilization management, and managed care, along with the ability to work independently in a remote setting.

Key Responsibilities

Care Management & Coordination

• Develop, implement, and manage individualized care plans based on member needs
• Assess members' clinical conditions, barriers to care, and social determinants of health
• Coordinate care between members, providers, specialists, and caregivers

Member Outreach & Clinical Support

• Perform inbound and outbound calls to provide clinical support and education
• Conduct assessments and deliver clinical interventions
• Educate members and families on disease management, treatment options, and benefits

Utilization Management & Compliance

• Apply utilization management principles and clinical guidelines (InterQual, NCCN)
• Ensure compliance with state, federal, and payer regulations
• Maintain accurate and timely documentation of care management activities

Collaboration & Workflow Management

• Manage assigned and pended worklists to ensure timely outreach and follow-up
• Collaborate with internal teams and provider offices to ensure optimal outcomes
• Participate in trainings, meetings, and system implementation initiatives (ScriptMed Cloud)

Monitoring & Continuous Care

• Monitor member progress and update care plans as needed
• Identify care gaps and implement appropriate interventions
• Provide feedback to leadership on care delivery improvements

Required Qualifications

• Associate's or Bachelor's Degree in Nursing
• Active RN License (State or Compact License required)
• 2+ years of clinical nursing experience (acute care, clinical, or community setting)
• 1+ year of case management experience in a managed care setting
• Strong knowledge of utilization management and managed care principles

Preferred Qualifications

• Experience with specialty pharmacy or pharmacy benefit management
• Familiarity with InterQual, NCCN, or other medical decision tools
• Experience with government-sponsored healthcare programs (Medicaid/Medicare)

Core Skills

• Care Coordination & Case Management
• Clinical Assessment & Patient Education
• Utilization Management
• Strong Communication & Telephonic Engagement
• Time Management & Multitasking
• Technical Proficiency in Remote Work Environments

Work Environment

• Fully remote (U.S.-based, excluding CA)
• High-volume telephonic care management role
• Collaborative, fast-paced managed care setting

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