Innovative Care Management, Inc.

Role Description 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. 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 Qualifications - 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

Role Description 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. 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 Qualifications - Active, unrestricted Registered Nurse (RN) license in good standing - Associate’s or Bachelor’s degree in Nursing - 5+ years of clinical nursing experience - OB, maternity, labor and delivery, postpartum, maternal-child health, or related 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) - Experience with maternity case management, high-risk pregnancy care coordination, or perinatal care management - 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

Role Description 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. 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 Qualifications - Active, unrestricted Registered Nurse (RN) license in good standing - Associate’s or Bachelor’s degree in Nursing - 5+ years of clinical nursing experience - Oncology nursing experience - Experience in case management - 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 Even Better If You Have - Case management or utilization certifications (e.g., CCM, CPUR, CPHM) - Oncology Certified Nurse certification, or OCN - Experience using NCCN Clinical Practice Guidelines in Oncology to support oncology case management, care coordination, or utilization review - 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

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 Oregon, Washington, Nevada, or Arizona. Schedule: Monday–Friday | 8:00 AM–5:00 PM Pacific Time 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 - 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 Even Better If You Have - Experience in case management, care coordination, or discharge planning - 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 - Mental health and/or substance use disorder (MH/SUD) case management experience - Multi-state licensure - Case management or utilization certifications (e.g., CCM, CPUR, CPHM)

About the role We’re looking for a relationship-driven Customer Success Manager (CSM) to join our Client Services team. In this role, you’ll serve as the primary point of contact for a portfolio of clients, owning the relationship from onboarding through renewal and beyond. You’ll partner closely with clients, brokers, TPAs, and internal teams to ensure a seamless experience, resolve issues, and deliver meaningful value. This role is ideal for someone who enjoys balancing day-to-day client support with strategic account management—and who takes pride in building trusted, long-term partnerships that drive satisfaction, retention, and growth. This is a fully remote role. Candidate must reside in Oregon or Washington. This is a primarily remote position; however, this position may require quarterly travel for client sites, conference or in person meetings. Reliable transportation, schedule flexibility, and the ability to work independently while traveling is essential. What You'll Do - Own and manage relationships for a portfolio of client accounts, serving as the primary point of contact - Lead regular client meetings, business reviews, and renewal coordination efforts - Proactively communicate with clients to provide updates, address concerns, and ensure a high level of satisfaction - Monitor account health, identifying risks and opportunities to strengthen relationships and expand services - Navigate complex or sensitive conversations with professionalism, including escalations and financial discussions - Respond to and resolve client, broker, and partner inquiries through collaboration with internal teams - Track client activity, service utilization, and performance trends, and provide insights through reporting - Ensure timely delivery of reports and proactively address any delays or issues - Maintain accurate documentation, including CRM updates, client records, and benefit materials - Support client-facing activities such as meetings, presentations, and events What You Bring - At least 3 years of experience in client services or account management within healthcare, health insurance, or medical management - Experience working with TPAs, brokers, consultants, or carriers - Strong organizational and time management skills, with the ability to manage multiple priorities independently - Excellent communication skills, with a high degree of professionalism, empathy, and emotional intelligence - Proven ability to problem-solve, manage escalations, and navigate complex client situations - Ability to work both independently and collaboratively in a fast-paced, remote environment - Comfort with CRM systems, reporting tools, and learning new technology platforms - Ability to handle confidential information in compliance with HIPAA Preferred: - Experience with renewals, retention strategies, and client presentations - Familiarity with self-funded health plans and medical terminology - Bachelor’s degree in healthcare, business, or a related field