Managed Care RN Consultant Job (Let’s Build the Future Tog – Indeed Jobs US

We are actively hiring a Managed Care RN Consultant to help shape the future of healthcare delivery. This remote position offers a unique opportunity to work collaboratively across care teams and insurance systems to improve health outcomes and optimize managed care solutions. You’ll bring your clinical expertise into a consultative environment where strategic thinking and compassionate care intersect.

Job Description:

As a Managed Care RN Consultant, you will serve as a vital link between patients, providers, and payers. Your responsibilities will include evaluating medical necessity, promoting cost-effective treatment, and supporting transitions of care. This position requires strong knowledge of managed care principles and excellent communication skills to collaborate across interdisciplinary teams. You’ll contribute to utilization review, care coordination, and policy implementation while helping to ensure patients receive timely, quality care.

Company Overview:

We are a values-driven healthcare consultancy committed to improving the lives of patients through innovative, data-driven, and equitable managed care strategies. Our team embraces diversity, continuous learning, and collaborative partnerships. We empower our team members to thrive professionally while making meaningful contributions to the future of care.

Requirements:

• Active, unrestricted RN license (Compact license preferred)

• 3+ years of clinical nursing experience

• Prior experience in managed care, utilization review, or case management

• Strong understanding of medical policy, insurance guidelines, and clinical documentation

• Excellent organizational, communication, and critical-thinking skills

• Ability to work independently in a remote setting with high attention to detail

• Proficiency with EMR systems and Microsoft Office Suite

Responsibilities:

• Review clinical data and documentation to assess medical necessity and appropriate levels of care

• Collaborate with care management teams to develop individualized care plans

• Provide consultation and guidance on healthcare cost containment strategies

• Assist in transitions of care and discharge planning

• Support quality assurance and compliance standards

• Educate patients, providers, and stakeholders on best practices in managed care

• Document activities accurately and maintain HIPAA compliance

Benefits:

• Competitive pay ranging from $38 to $52 per hour

• 100% remote work with flexible scheduling

• Health, dental, and vision insurance

• Generous PTO and paid holidays

• Opportunities for career advancement and training

• Inclusive and innovative company culture

How to Apply:

Interested applicants should submit a resume and cover letter outlining relevant experience and interest in the position. We are looking to fill this role immediately and encourage qualified candidates to apply today to join our mission-driven team.