Case Management Nurse - Transplant Experience
About The Role
The Case Manager Nurse plays a critical role in supporting members with complex or chronic conditions by providing proactive, telephonic case management grounded in a whole-person approach. This role focuses on reducing avoidable utilization, improving care coordination, and helping members navigate the healthcare system with confidence and clarity.
As a trusted clinical resource, the Case Manager Nurse partners closely with members, providers, and health plans to assess needs, develop individualized care plans, and advocate for appropriate, cost-effective services. In addition to core case management responsibilities, this role also supports utilization review activities when needed, contributing to timely medical necessity determinations and continuity of care.
This position is ideal for an experienced RN who brings strong clinical judgment, excellent communication skills, and a passion for improving outcomes for high-need populations in a collaborative, remote care management environment.
This is a fully remote role. Candidates must reside in Iowa, Arizona, or Idaho.
Schedule: This position works four 10-hour shifts per week and must be able to support ICM’s standard operating hours of 8:00 AM–5:00 PM Pacific Time. Specific shift times may vary based on business needs and the candidate’s time zone. For example, a candidate residing in Iowa may have a shift that begins earlier in Central Time, such as 7:00 AM or 8:00 AM CT, depending on coverage needs.
What You'll Do
Patient Identification & Assessment
Identify members who would benefit from case management using claims data, referrals, and clinical records
Review referrals for clinical appropriateness using sound judgment and program parameters
Conduct comprehensive assessments of medical, behavioral, and social needs using a whole-person approach
Care Planning & Coordination
Develop individualized care plans based on patient needs, barriers, and goals
Coordinate care across the continuum, including primary care, specialists, behavioral health, and community-based resources
Facilitate clear communication between patients, providers, caregivers, and health plans to support safe transitions of care and adherence to treatment plans
Clinical Case Management & Advocacy
Provide telephonic case management for high-utilization patients with complex or chronic conditions
Use best practices in chronic disease management, motivational interviewing, and patient education
Advocate for timely, appropriate, and cost-effective care while balancing clinical judgment with plan guidelines
Support patients in navigating healthcare systems and overcoming barriers to care
Utilization Review & Medical Decision-Making
Evaluate precertification requests using evidence-based criteria and plan-specific guidelines
Review ongoing inpatient stays and make length-of-stay determinations as appropriate
Partner with Appeals & Denials and/or in-house providers to support complex clinical decisions
Documentation, Reporting & Compliance
Document all assessments, interventions, communications, and determinations thoroughly and accurately in ICM systems
Provide client-facing reports summarizing interventions, outcomes, and estimated cost savings
Ensure compliance with internal policies, regulatory requirements, and HIPAA standards
Collaboration, Leadership & Continuous Improvement
Partner with other clinical teams across ICM to remove care barriers and improve patient outcomes
Serve as a senior clinical resource, contributing to program development, cross-training, and process improvement
Stay current on best practices, regulations, and clinical guidelines related to case management
Participate in training, quality assurance initiatives, and professional development
What You Bring
Required
Active, unrestricted Registered Nurse (RN) license in good standing
Associate’s or Bachelor’s degree in Nursing
5+ years of clinical nursing experience
Transplant (living donor, HSCT, tissue) nursing experience
Strong knowledge of chronic disease management, utilization management, and social determinants of health
Experience managing complex, high-utilization patient populations
Excellent written and verbal communication skills with empathy, professionalism, and emotional intelligence
Strong organizational skills with the ability to manage multiple priorities independently
Sound clinical judgment and confidence navigating complex or sensitive situations
Comfort working independently in a remote environment with strong accountability and follow-through
Ability to manage confidential information in compliance with HIPAA
Must reside in Iowa, Arizona, or Idaho
Ability to work four 10-hour shifts per week and support coverage during ICM’s standard operating hours of 8:00 AM–5:00 PM Pacific Time
Even Better If You Have
Case management or utilization certifications (e.g., CCM, CPUR, CPHM)
Certified Clinical Transplant Nurse (CCTN) credential
Certification through the American Association of Transplant Management (AATM)
Experience in case management
Experience in a TPA or self-funded health plan environment
Knowledge of health insurance regulations and utilization management processes
Experience using medical necessity criteria and utilization review tools
Experience with EMRs and care management platforms
Multi-state licensure
The Case Manager Nurse plays a critical role in supporting members with complex or chronic conditions by providing proactive, telephonic case management grounded in a whole-person approach. This role focuses on reducing avoidable utilization, improving care coordination, and helping members navigate the healthcare system with confidence and clarity.
As a trusted clinical resource, the Case Manager Nurse partners closely with members, providers, and health plans to assess needs, develop individualized care plans, and advocate for appropriate, cost-effective services. In addition to core case management responsibilities, this role also supports utilization review activities when needed, contributing to timely medical necessity determinations and continuity of care.
This position is ideal for an experienced RN who brings strong clinical judgment, excellent communication skills, and a passion for improving outcomes for high-need populations in a collaborative, remote care management environment.
This is a fully remote role. Candidates must reside in Iowa, Arizona, or Idaho.
Schedule: This position works four 10-hour shifts per week and must be able to support ICM’s standard operating hours of 8:00 AM–5:00 PM Pacific Time. Specific shift times may vary based on business needs and the candidate’s time zone. For example, a candidate residing in Iowa may have a shift that begins earlier in Central Time, such as 7:00 AM or 8:00 AM CT, depending on coverage needs.
What You'll Do
Patient Identification & Assessment
Identify members who would benefit from case management using claims data, referrals, and clinical records
Review referrals for clinical appropriateness using sound judgment and program parameters
Conduct comprehensive assessments of medical, behavioral, and social needs using a whole-person approach
Care Planning & Coordination
Develop individualized care plans based on patient needs, barriers, and goals
Coordinate care across the continuum, including primary care, specialists, behavioral health, and community-based resources
Facilitate clear communication between patients, providers, caregivers, and health plans to support safe transitions of care and adherence to treatment plans
Clinical Case Management & Advocacy
Provide telephonic case management for high-utilization patients with complex or chronic conditions
Use best practices in chronic disease management, motivational interviewing, and patient education
Advocate for timely, appropriate, and cost-effective care while balancing clinical judgment with plan guidelines
Support patients in navigating healthcare systems and overcoming barriers to care
Utilization Review & Medical Decision-Making
Evaluate precertification requests using evidence-based criteria and plan-specific guidelines
Review ongoing inpatient stays and make length-of-stay determinations as appropriate
Partner with Appeals & Denials and/or in-house providers to support complex clinical decisions
Documentation, Reporting & Compliance
Document all assessments, interventions, communications, and determinations thoroughly and accurately in ICM systems
Provide client-facing reports summarizing interventions, outcomes, and estimated cost savings
Ensure compliance with internal policies, regulatory requirements, and HIPAA standards
Collaboration, Leadership & Continuous Improvement
Partner with other clinical teams across ICM to remove care barriers and improve patient outcomes
Serve as a senior clinical resource, contributing to program development, cross-training, and process improvement
Stay current on best practices, regulations, and clinical guidelines related to case management
Participate in training, quality assurance initiatives, and professional development
What You Bring
Required
Active, unrestricted Registered Nurse (RN) license in good standing
Associate’s or Bachelor’s degree in Nursing
5+ years of clinical nursing experience
Transplant (living donor, HSCT, tissue) nursing experience
Strong knowledge of chronic disease management, utilization management, and social determinants of health
Experience managing complex, high-utilization patient populations
Excellent written and verbal communication skills with empathy, professionalism, and emotional intelligence
Strong organizational skills with the ability to manage multiple priorities independently
Sound clinical judgment and confidence navigating complex or sensitive situations
Comfort working independently in a remote environment with strong accountability and follow-through
Ability to manage confidential information in compliance with HIPAA
Must reside in Iowa, Arizona, or Idaho
Ability to work four 10-hour shifts per week and support coverage during ICM’s standard operating hours of 8:00 AM–5:00 PM Pacific Time
Even Better If You Have
Case management or utilization certifications (e.g., CCM, CPUR, CPHM)
Certified Clinical Transplant Nurse (CCTN) credential
Certification through the American Association of Transplant Management (AATM)
Experience in case management
Experience in a TPA or self-funded health plan environment
Knowledge of health insurance regulations and utilization management processes
Experience using medical necessity criteria and utilization review tools
Experience with EMRs and care management platforms
Multi-state licensure