Case Management Nurse - Behavioral Health Focus (Remote – AZ Only)
Posted 2025-08-15
Remote, USA
Full Time
Immediate Start
Description:Position Summary:
The Case Manager is a highly experienced nurse who supports high-utilization patients with complex or chronic conditions through proactive, telephonic case management. Using a whole-person approach, Case Managers assess needs, coordinate care, educate patients, and reduce avoidable utilization. This role serves as a trusted resource to patients and a strategic partner to providers and health plans, driving better outcomes and more efficient use of resources. The Case management nurse is also responsible for evaluating medical necessity requests and ongoing hospital stays to ensure services are clinically appropriate, cost-effective, and in line with plan guidelines/criteria. This role supports timely decision-making through thorough clinical review, accurate documentation, and adherence to regulatory standards.
We are specifically seeking candidates with at least 1 year of experience in mental health and/or substance use nursing, along with related case management expertise. Ideal applicants are comfortable supporting complex behavioral health needs and are committed to ongoing learning in this area.
This is a remote position; however, due to regulatory and operational requirements, we are only considering candidates who reside in Idaho or Arizona at this time.
Specific Position Requirements & Responsibilities:
Patient Identification & Assessment
• Helps identify CM needs of members utilizing claims/payor and clinical health records and data
• Review referrals for clinical appropriateness using sound judgment and understanding of program parameters.
• Conduct comprehensive assessments of patients’ medical, behavioral, and social needs.
Care Planning & Coordination
• Develop individualized care plans based on patient needs, barriers, and goals.
• Facilitate communication between patients, providers, and caregivers to support safe, coordinated care transitions and adherence to treatment plans.
• Identify and connect patients to appropriate services across the continuum—including specialists, community-based programs, and behavioral health resources.
Clinical Management & Advocacy
• Deliver case management using best practices in chronic disease management, motivational interviewing, and patient education.
• Advocate for timely, appropriate, and cost-effective services, balancing clinical judgment and plan guidelines.
• Perform utilization review functions when appropriate, including length-of-stay reviews and service authorizations.
Documentation & Reporting
• Maintain complete, clear, and timely documentation in ICM systems in accordance with program standards.
• Provide accurate reports to clients summarizing interventions, outcomes, and estimated cost savings.
• Ensure adherence to established policies and procedures during the review process.
• Adhere to plan-specific guidelines and evidence-based criteria in medical necessity determinations.
• Accurately document all communications, medical necessity decisions, and patient-related interventions using ICM software.
Medical Review & Decision-Making:
• Evaluate precertification requests for medical necessity based on industry guidelines and plan-specific criteria.
• Assess clinical information for ongoing hospital stays, extending the length of stay as appropriate to ensure efficient utilization of resources.
• Utilize Appeals and Denials and/or in-house providers as needed to assist with complex cases.
Continuous Learning & Improvement:
• Stay updated on industry best practices, regulations, and clinical guidelines related to case management.
• Participate in internal training, quality assurance initiatives, and professional development opportunities.
Internal Collaboration & Leadership
• Partner with other clinical teams across ICM to share insights, resolve care barriers, and optimize patient outcomes.
• Participate in program development, process improvement, and cross-training efforts as a senior clinical resource.
• Other duties as assigned
Work Experience, Qualifications, Additional Skill and Abilities, and Professional Competencies:
Required:
• Minimum of 5 years of clinical nursing experience
• At least 1 year of experience with Mental health/ Substance Use nursing and case management
• Strong understanding of chronic disease management, utilization management, and social determinants of health.
• Strong critical thinking, communication, and problem-solving abilities.
• Ability to work independently and as part of a team in a fast-paced environment.
• Proficient in clinical documentation systems and Microsoft Office.
• Demonstrated ability to build rapport with patients and communicate effectively with providers
Preferred:
• Minimum of 1 year in a case management, care coordination, or discharge planning role
• Experience in a Third-Party Administrator (TPA) or self-funded insurance setting.
• Strong knowledge of health insurance regulations and self-funded health plans.
• Experience using medical necessity guidelines.
• Experience using electronic medical records (EMR) and utilization review software.
Education, Licensure, and Certification Requirements:
Required:
• Associate’s or Bachelor’s degree in Nursing.
• Active and unrestricted Registered Nurse (RN) license in good standing.
• Demonstrated ability to provide clinical support, mentor team members, and represent staff in leadership settings.
• Must obtain sufficient continuing education to maintain active licensure in each state where continuing education units (CEUs) are required.
• Willingness to obtain additional state licensure as needed.
• Willingness to obtain a Certified Case Manager (CCM) within 5 years of hire.
Preferred:
• Multi-state licensure preferred.
• Additional certification in case management, healthcare management, or utilization review (e.g., CCM, CPHM, CPUR).
Work and Physical Conditions:
• This role is performed remotely. Employees must have access to a quiet, distraction-free workspace and reliable high-speed internet. The company will provide necessary equipment and technical support, as applicable.
• All employees must be able to work in environments that comply with HIPAA privacy and confidentiality standards and must ensure the protection of sensitive data.
• Requires long periods of sitting and frequent use of a computer, including tasks involving data entry, document review, virtual meetings, and other digital tools.
• Frequent verbal and written communication is expected. Employees must be able to talk, hear, and view screen-based communications clearly for extended periods.
• This position is primarily sedentary but may occasionally require light physical activity such as moving within a workspace, retrieving files, or carrying office equipment weighing up to 15 pounds.
• Reasonable accommodation may be provided to enable individuals with disabilities to perform the essential functions of this job.
Benefits:
• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Professional development assistance
• Retirement plan
• Vision insurance
Work Location: Remote Apply tot his job
The Case Manager is a highly experienced nurse who supports high-utilization patients with complex or chronic conditions through proactive, telephonic case management. Using a whole-person approach, Case Managers assess needs, coordinate care, educate patients, and reduce avoidable utilization. This role serves as a trusted resource to patients and a strategic partner to providers and health plans, driving better outcomes and more efficient use of resources. The Case management nurse is also responsible for evaluating medical necessity requests and ongoing hospital stays to ensure services are clinically appropriate, cost-effective, and in line with plan guidelines/criteria. This role supports timely decision-making through thorough clinical review, accurate documentation, and adherence to regulatory standards.
We are specifically seeking candidates with at least 1 year of experience in mental health and/or substance use nursing, along with related case management expertise. Ideal applicants are comfortable supporting complex behavioral health needs and are committed to ongoing learning in this area.
This is a remote position; however, due to regulatory and operational requirements, we are only considering candidates who reside in Idaho or Arizona at this time.
Specific Position Requirements & Responsibilities:
Patient Identification & Assessment
• Helps identify CM needs of members utilizing claims/payor and clinical health records and data
• Review referrals for clinical appropriateness using sound judgment and understanding of program parameters.
• Conduct comprehensive assessments of patients’ medical, behavioral, and social needs.
Care Planning & Coordination
• Develop individualized care plans based on patient needs, barriers, and goals.
• Facilitate communication between patients, providers, and caregivers to support safe, coordinated care transitions and adherence to treatment plans.
• Identify and connect patients to appropriate services across the continuum—including specialists, community-based programs, and behavioral health resources.
Clinical Management & Advocacy
• Deliver case management using best practices in chronic disease management, motivational interviewing, and patient education.
• Advocate for timely, appropriate, and cost-effective services, balancing clinical judgment and plan guidelines.
• Perform utilization review functions when appropriate, including length-of-stay reviews and service authorizations.
Documentation & Reporting
• Maintain complete, clear, and timely documentation in ICM systems in accordance with program standards.
• Provide accurate reports to clients summarizing interventions, outcomes, and estimated cost savings.
• Ensure adherence to established policies and procedures during the review process.
• Adhere to plan-specific guidelines and evidence-based criteria in medical necessity determinations.
• Accurately document all communications, medical necessity decisions, and patient-related interventions using ICM software.
Medical Review & Decision-Making:
• Evaluate precertification requests for medical necessity based on industry guidelines and plan-specific criteria.
• Assess clinical information for ongoing hospital stays, extending the length of stay as appropriate to ensure efficient utilization of resources.
• Utilize Appeals and Denials and/or in-house providers as needed to assist with complex cases.
Continuous Learning & Improvement:
• Stay updated on industry best practices, regulations, and clinical guidelines related to case management.
• Participate in internal training, quality assurance initiatives, and professional development opportunities.
Internal Collaboration & Leadership
• Partner with other clinical teams across ICM to share insights, resolve care barriers, and optimize patient outcomes.
• Participate in program development, process improvement, and cross-training efforts as a senior clinical resource.
• Other duties as assigned
Work Experience, Qualifications, Additional Skill and Abilities, and Professional Competencies:
Required:
• Minimum of 5 years of clinical nursing experience
• At least 1 year of experience with Mental health/ Substance Use nursing and case management
• Strong understanding of chronic disease management, utilization management, and social determinants of health.
• Strong critical thinking, communication, and problem-solving abilities.
• Ability to work independently and as part of a team in a fast-paced environment.
• Proficient in clinical documentation systems and Microsoft Office.
• Demonstrated ability to build rapport with patients and communicate effectively with providers
Preferred:
• Minimum of 1 year in a case management, care coordination, or discharge planning role
• Experience in a Third-Party Administrator (TPA) or self-funded insurance setting.
• Strong knowledge of health insurance regulations and self-funded health plans.
• Experience using medical necessity guidelines.
• Experience using electronic medical records (EMR) and utilization review software.
Education, Licensure, and Certification Requirements:
Required:
• Associate’s or Bachelor’s degree in Nursing.
• Active and unrestricted Registered Nurse (RN) license in good standing.
• Demonstrated ability to provide clinical support, mentor team members, and represent staff in leadership settings.
• Must obtain sufficient continuing education to maintain active licensure in each state where continuing education units (CEUs) are required.
• Willingness to obtain additional state licensure as needed.
• Willingness to obtain a Certified Case Manager (CCM) within 5 years of hire.
Preferred:
• Multi-state licensure preferred.
• Additional certification in case management, healthcare management, or utilization review (e.g., CCM, CPHM, CPUR).
Work and Physical Conditions:
• This role is performed remotely. Employees must have access to a quiet, distraction-free workspace and reliable high-speed internet. The company will provide necessary equipment and technical support, as applicable.
• All employees must be able to work in environments that comply with HIPAA privacy and confidentiality standards and must ensure the protection of sensitive data.
• Requires long periods of sitting and frequent use of a computer, including tasks involving data entry, document review, virtual meetings, and other digital tools.
• Frequent verbal and written communication is expected. Employees must be able to talk, hear, and view screen-based communications clearly for extended periods.
• This position is primarily sedentary but may occasionally require light physical activity such as moving within a workspace, retrieving files, or carrying office equipment weighing up to 15 pounds.
• Reasonable accommodation may be provided to enable individuals with disabilities to perform the essential functions of this job.
Benefits:
• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Professional development assistance
• Retirement plan
• Vision insurance
Work Location: Remote Apply tot his job