Remote RN Case Manager — Care Coordination & Outcomes

GuideWell; United States; Hybrid; USD 75,000 - 105,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

Retirement plan

Paid time off

Job summary

WebTPA, a GuideWell Company, is seeking an RN Case Manager to create, implement, and monitor treatment plans for members. You will assess needs, coordinate care, and work with providers to ensure quality, cost-effective plans.

This role requires nursing licensure and strong clinical judgment, with opportunities to collaborate across teams. The position emphasizes interdisciplinary care planning, documentation, and compliance with plan provisions.

Qualifications

• 5+ years related work experience with a professional background in clinical nursing and patient assessment.
• Bachelor’s degree or additional related equivalent work experience.
• Graduate of an accredited school of nursing and RN licensure.

Responsibilities

• Assess member health status and care coordination needs, including potential inpatient review and discharge planning.
• Coordinate contact with patients, families, physicians, and employer/client representatives.
• Identify alternative treatment plans within quality and cost guidelines and obtain approvals.
• Monitor and adjust care plans based on changing client needs and clinical status.
• Identify services and providers to optimize value and reimbursement.
• Develop and implement short- and long-term Case Management goals with documented plans.
• Utilize technology to evaluate cost-effectiveness and report outcomes to clients.
• Perform medical record reviews to determine medical necessity and interpret health plans.

Skills

Case management

RN Case Manager

Care coordination

Interdisciplinary collaboration

Education

Bachelor’s degree in Nursing

RN Licensure

Graduate of accredited nursing program

Job description

WebTPA, a GuideWell Company, is seeking an RN Case Manager to create, implement, and monitor treatment plans for members. You will assess needs, coordinate care, and work with providers to ensure quality, cost-effective plans.

This role requires nursing licensure and strong clinical judgment, with opportunities to collaborate across teams. The position emphasizes interdisciplinary care planning, documentation, and compliance with plan provisions.