Remote RN Case Manager — Care Coordination Expert

MedWatch; Town of Florida (NY); On-site; USD 72,000 - 81,000; Full time

Job summary

MedWatch is seeking a Registered Nurse Case Manager to manage an individual caseload remotely, coordinating services, reviewing treatment plans for medical necessity, and maintaining active communication with the health care team. This home-based role emphasizes URAC-aligned certification progression within 3 years of hire.

The salary range is $72,000 to $81,000 annually, with eligibility for a bonus program.

Qualifications

• 7 years of varied clinical experience preferred.
• RN license in active status in the US or territories.
• URAC-recognized certification in Case Management within 3 years of hire.

Responsibilities

• Practice within the scope of licensure.
• Review medical data to establish/update case management plans with providers, payers, patient and caregiver.
• Assess problems, set goals and actions, document case notes.
• Contact payer offices to understand benefit constraints affecting plan of action.
• Coordinate with providers and equipment vendors to verify medical necessity.
• Arrange care according to physician orders and patient needs.
• Maintain case-management files with the Case Management Assistant; input in annual performance evaluations.
• Explore alternate treatments and cost-benefit analyses for non-beneficial options.
• Familiarize with community resources to maximize health benefit dollars.
• Maintain billing in the computer system and ongoing contact with providers/patients across the continuum of care.
• Negotiate with providers to maximize benefits; make network referrals as appropriate.
• Adhere to company policies and pursue URAC certification within 3 years.

Skills

Case management

Healthcare coordination

Communication skills

Remote work readiness

Education

RN license (US)

Bachelor’s degree in health-related field (preferred)

URAC-recognized case management certification (within 3 years)

Job description

MedWatch is seeking a Registered Nurse Case Manager to manage an individual caseload remotely, coordinating services, reviewing treatment plans for medical necessity, and maintaining active communication with the health care team. This home-based role emphasizes URAC-aligned certification progression within 3 years of hire.

The salary range is $72,000 to $81,000 annually, with eligibility for a bonus program.