Clinical Case Manager
Job Description
Evaluate care-coordination decisions from admission through post-acute arrangements.
What you will do
• Create discharge and coordination cases with realistic care needs.
• Explain level-of-care decisions and benefit considerations.
• Assess clinical appropriateness and coverage accuracy; identify plans likely to leave a patient without suitable care or cause an avoidable denial.
Required background
• An active RN or LCSW license, or CCM certification.
• At least two years of case management in a hospital, payer or community setting.
• Practical expertise coordinating complex care, planning discharge or reviewing utilization.
• Clear written English for explaining professional decisions and reasoning.
• Availability for at least 10 hours per week.
Preferred background
• CCM or ACM certification.
• InterQual or MCG criteria experience.
• Payer utilization management or appeals practice.
Availability
• Remote and asynchronous, with at least 10 hours available weekly and no fixed daily hours.
Pay and engagement
$74–$121/hr
Amounts are in USD. The applicable rate or fee and work requirements are agreed before you begin.