Nurse Case Management Senior Analyst

• Job Title: Nurse Case Management Senior Analyst
• Location: Remote
• Contract duration: 3 months
• Schedule: 8am to 5pm (M-F)

Job Description:

• We are hiring an RN Nurse Case Manager with strong experience in Utilization Management (UM) and Quality Improvement (QI).
• In this role, you will manage a caseload of members, coordinate care, conduct clinical assessments, and perform prospective, concurrent, and retrospective utilization reviews. You will collaborate with providers to ensure quality, cost-effective care while supporting inpatient, rehabilitation, referrals, prior authorizations, appeals, claims, and select outpatient services.

Required Qualifications:

• Active, unrestricted RN license
• 3–5 years of experience in Utilization Management or Quality Improvement
• Strong experience with utilization review, prior authorizations, appeals, and claims
• Experience managing member caseloads and coordinating care
• Knowledge of inpatient acute care, rehabilitation, referrals, and outpatient services

Please Note:

Candidates should have dedicated experience in Utilization Management, Utilization Review, Quality Improvement, or Quality Review roles. Clinical nursing experience alone is not sufficient.