Nurse Case Manager Remote (PartTime) Job at Criterion Executive Search, Remote

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  • Criterion Executive Search
  • Remote

Job Description

Nurse Case Manager – Stop Loss | Remote & Part-time
Are you a nurse looking for flexible, remote work that leverages your clinical expertise? We're a growing insurance organization specializing in stop-loss insurance, seeking an experienced Nurse Case Manager to help us evaluate complex claims and guide cost-effective care solutions.
 
What You'll Do:
  • Review and analyze high-cost medical claims to assess appropriateness, necessity, and cost-effectiveness of treatment.
  • Collaborate with underwriters to evaluate potential stop-loss clients and understand group risk profiles.
  • Identify alternative treatment options and cost-saving opportunities without compromising patient care quality.
  • Leverage your medical network and resources to navigate hospital systems, negotiate solutions, and facilitate optimal outcomes.
  • Act as a trusted advisor and collaborator working diplomatically with providers, claimants, and internal teams to find a win-win solution.
  • Provide clinical insights that helps our underwriting team make informed decisions on group coverage.
 
What We're Looking For:
  • Medical Case Manager with 5+ years of hands-on medical experience.
  • Hospital, clinical, or cost containment background —NOT working for insurance carrier or MGU.
  • Deep understanding of medical billing, treatment protocols, and healthcare costs.
  • Strong professional network and ability to navigate hospital politics tactfully.
  • Problem-solver who can identify creative alternatives that balance patient care with financial realities.
  • Excellent communication skills and ability to explain complex medical information to non-clinical stakeholders.
  • Self-motivated and comfortable working independently in a remote environment.
 
Ideal Candidates Include:
  • Hospital nurses seeking remote part-time work; Semi-retired nurses; Stay-at-home parents with nursing backgrounds; Cost containment or utilization review nurses ready for a change

Job Tags

Part time, Remote work, Flexible hours

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