RN - Case Manager

Cynet Health; Somerville (MA); Remote; USD 85,000 - 110,000; Full time

Job summary

Cynet Health is seeking a remote RN Case Manager in the U.S. to support utilization review activities across multiple lines of business. This full-time role requires Massachusetts RN licensure and experience in utilization management, with remote work options available.

Candidates should have 2–4 years in utilization management, managed care exposure, and familiarity with Medicaid, Medicare, and commercial products. InterQual not required but knowledge is advantageous.

Qualifications

• Utilization Management experience
• Managed care experience
• Line of Business experience (Medicaid, Medicare, Commercial products)
• EPIC experience preferred

Skills

Utilization Management

Managed Care

Line of Business experience

Tools

EPIC

Job description

RN - Case Manager

Profession: Registered Nurse

Specialty: Utilization Review

Duration: 11 months

Shift: Remote Position

Hours per Shift: Full-time, Monday to Friday, 8 AM to 5 PM, or Fri, Sat, Sun, Mon, 10-hour days, options from 6 AM to 8 PM

Experience: 2-4 years in Utilization Management

License: Massachusetts RN License

Certifications: Interqual

Must-Have:

• Utilization Management experience
• Managed care experience
• Line of Business experience (Medicaid, Medicare, Commercial products)
• EPIC experience preferred

Description:This position is remote.There are three full-time positions available for Monday to Friday, 8 AM to 5 PM.One position requires weekend work on Fri, Sat, Sun, and Mon, with 10-hour shifts from 6 AM to 6 PM, 7 AM to 7 PM, or 8 AM to 8 PM.Candidates must have a current Massachusetts RN license.Experience with Interqual is necessary.Two to four years of Utilization Management experience is required.Candidates should have two to four years of managed care experience.Experience with Medicaid, Medicare, and Commercial products is essential.Knowledge of EPIC software is preferred.