Remote Utilization Care Manager (RN/LPN)

Piper Companies; North Carolina; Remote; USD 65,000 - 80,000; Full time

Benefits offered by this job

Fully remote

Job summary

Piper Companies is seeking an Episodic Care Manager for a fully remote opportunity within the healthcare and managed care industry.

This Episodic Care Manager position is a long-term contract role responsible for conducting utilization reviews, evaluating medical necessity, coordinating clinical determinations, and collaborating with providers and internal healthcare teams to support quality member outcomes.

Qualifications

• Active RN or LPN license with relevant clinical experience.
• Valid NC nursing license or active compact license required.
• Experience with utilization management and health plan benefits.
• Ability to analyze clinical records and present concise assessments.
• Strong written and verbal communication in a remote setting.

Responsibilities

• Perform clinical assessments for inpatient, outpatient, DME requests to determine coverage.
• Apply medical policies and guidelines when reviewing cases for authorization.
• Coordinate with physicians, nurses, providers, and teams to ensure timely resolutions.
• Prepare case documentation and clinical summaries in compliance with quality standards.
• Escalate complex cases for physician review and communicate outcomes to members and providers.

Skills

Utilization management

Medical necessity review

Clinical assessment

Regulatory compliance

Remote work

Documentation

Communication

Healthcare policies

Education

RN or LPN license

Job description

Piper Companies is seeking an Episodic Care Manager for a fully remote opportunity within the healthcare and managed care industry.

This Episodic Care Manager position is a long-term contract role responsible for conducting utilization reviews, evaluating medical necessity, coordinating clinical determinations, and collaborating with providers and internal healthcare teams to support quality member outcomes.