Case Management Nurse - Transplant Experience

About Innovative Care Management In an increasingly complex healthcare environment, ICM remains focused on something essential: putting people at the center of every decision. We are dedicated to ensuring that members and health plans feel genuinely seen, heard, and supported throughout their care journey. We serve clients nationwide with a values-driven approach that blends compassion, clinical expertise, and operational excellence. Our core values: Kindness, Personal Responsibility, a Can-Do Attitude, and Humble Confidence, shape how we work, how we lead, and how we care for those we serve. As we grow, we welcome individuals who share our belief that healthcare should be effective, compassionate, and truly centered on people. 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