Case Management Nurse (NCLEX)

Alight Solutions Ltd; Chennai; On-site; INR 450,000 - 750,000; Full time

Job summary

Alight Solutions Ltd is seeking an experienced Nurse Case Manager to review medical records, coordinate care plans, and support utilization and claims-related reviews in a US-night shift setting.

The ideal candidate holds NCLEX-RN certification and nursing qualifications, with strong clinical knowledge and good English communication skills to collaborate with members, providers, and internal teams. Prior medical-record review, case management, or healthcare operations experience is preferred.

Qualifications

• NCLEX-RN certification is mandatory.
• B.Sc. Nursing, Post Basic B.Sc. Nursing, or M.Sc. Nursing.
• Valid nursing registration from the appropriate Nursing Council.
• Strong clinical knowledge and understanding of medical terminology.
• Experience in bedside nursing, case management, clinical review, medical-record review, claims review, utilization management, or healthcare operations.
• Good understanding of diagnoses, medications, treatment plans, and patient-care documentation.
• Strong written and verbal English communication skills.
• Comfortable working in US shifts or night shifts.
• Good computer skills and experience working with electronic medical records or healthcare applications.

Responsibilities

• Review patients’ medical records, diagnoses, treatment plans, medications, and clinical history.
• Assess members’ healthcare needs and identify appropriate care-management interventions.
• Develop, document, and monitor individualized care plans.
• Coordinate with physicians, hospitals, healthcare providers, members, and internal teams.
• Conduct telephonic or virtual assessments and provide appropriate clinical guidance.
• Educate members regarding treatment plans, medication adherence, follow-up care, and available healthcare resources.
• Monitor patient progress and update care plans based on clinical requirements.
• Review clinical claims and supporting medical documentation when required.
• Identify gaps in care, potential health risks, and opportunities for improved clinical outcomes.
• Maintain complete and accurate case notes in accordance with established procedures and quality standards.
• Ensure compliance with clinical protocols, confidentiality requirements, and organizational policies.
• Meet applicable productivity, quality, and turnaround-time expectations.
• Escalate complex or high-risk cases to the appropriate clinical or medical team.

Skills

Clinical nursing

Medical-record review

Utilization management

Claims review

Communication skills

English proficiency

US shift readiness

EMR systems

Education

B.Sc. Nursing

Post Basic B.Sc. Nursing

M.Sc. Nursing

Nursing registration

Tools

EMR software

Healthcare applications

Job description

Shift: US Shift / Night Shift, as per business requirements

Mandatory Certification: NCLEX-RN certification

Job Summary

We are looking for an experienced Nurse Case Manager with active or completed NCLEX-RN certification and strong clinical nursing knowledge. The candidate will be responsible for reviewing medical records, assessing patients’ healthcare needs, coordinating care plans, supporting utilization and claims-related reviews, and communicating with members, healthcare providers, and internal teams.

The ideal candidate should have experience in clinical nursing, medical-record review, clinical claims, healthcare operations, case management, utilization management, or a related healthcare process.

Key Responsibilities

• Review patients’ medical records, diagnoses, treatment plans, medications, and clinical history.
• Assess members’ healthcare needs and identify appropriate care-management interventions.
• Develop, document, and monitor individualized care plans.
• Coordinate with physicians, hospitals, healthcare providers, members, and internal teams.
• Conduct telephonic or virtual assessments and provide appropriate clinical guidance.
• Educate members regarding treatment plans, medication adherence, follow-up care, and available healthcare resources.
• Monitor patient progress and update care plans based on clinical requirements.
• Review clinical claims and supporting medical documentation when required.
• Identify gaps in care, potential health risks, and opportunities for improved clinical outcomes.
• Maintain complete and accurate case notes in accordance with established procedures and quality standards.
• Ensure compliance with clinical protocols, confidentiality requirements, and organizational policies.
• Meet applicable productivity, quality, and turnaround-time expectations.
• Escalate complex or high-risk cases to the appropriate clinical or medical team.

Mandatory Requirements

• NCLEX-RN certification is mandatory.
• B.Sc. Nursing, Post Basic B.Sc. Nursing, or M.Sc. Nursing.
• Valid nursing registration from the appropriate Nursing Council.
• Strong clinical knowledge and understanding of medical terminology.
• Experience in bedside nursing, case management, clinical review, medical-record review, claims review, utilization management, or healthcare operations.
• Good understanding of diagnoses, medications, treatment plans, and patient-care documentation.
• Strong written and verbal English communication skills.
• Comfortable working in US shifts or night shifts.
• Good computer skills and experience working with electronic medical records or healthcare applications.