Top 25428 Manager Nursing Jobs

Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
Quick Apply
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
Clinical Services Assistant Manager
EMC Insurance —Remote
- $100,085 - $152,122 a year
- Full-time
- Nursing
- RN License
- 8 years
- Work from home
8d
Case Manager / RN
MedWatch —Remote
- $72,000 - $81,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Residential
Remote Behavioral Registered Nurse (RN)– Remote Care Manager
CareGenix Solutions LLC —Remote
- Part-time
- Remote
- Nursing
- RN License
- HIPAA
Quick Apply
Remote Case Manager (RN)
CORE Occupational Medicine —Baton Rouge, LA
- $70,000 a year
- Full-time
- Remote
- RN License
- Mid-level
- High school diploma or GED
- Paid holidays
- Disability insurance
Quick Apply
Clinical Case Manager-RN
For The People of Georgia, LLC —Atlanta, GA
- $100 - $500 a day
- Contract
- Remote
- Nursing
- Mid-level
- Bachelor's degree
- Flexible schedule
Quick Apply
RN Case Manager
Zócalo Health —Remote
- $85,000 a year
- Full-time
- Remote
- RN License
- Writing skills
- Mid-level
- Health insurance
- Dental insurance
Manager, inpatient Nursing Behavior Health
Sutter Health —Berkeley, CA
- $222,227.20 - $355,576.00 a year
- Weekends as needed
- Nursing
- RN License
- Hospital
10d
Virtual Nurse Case Manager/Neurology (12-9p EST)
Momentum Life Sciences —Remote
- $38 - $40 an hour
- Full-time
- Remote
- Nursing
- RN License
- English
Social Work Case Manager
Devoted Health —Remote
- $70,000 - $85,000 a year
- Full-time
- Spanish
- Writing skills
- Mid-level
- Dental insurance
- 401(k)
9d
Clinical Case Manager (Wound Care)
OX BioMed —Remote
- $0 a year
- Online Application
- Remote
- HIPAA
- Mid-level
- Data entry
Quick Apply
Care Continuity & Patient Retention Manager
Call On Doc —Remote
- $65,000 - $70,000 a year
- Full-time
- Remote
- Nursing
- 5 years
- Analysis skills
- 401(k)
- Paid time off
Quick Apply
Case Manager, Registered Nurse (Oncology experience required)
CVS Health —North Carolina
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
RN/LVN SNP Telephonic Case Manager I
Desert Oasis Healthcare —Palm Springs, CA
- $42.09 - $51.67 an hour
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
9d
Case Manager-Field Coordinator
For The People of Georgia, LLC —Atlanta, GA
- $50 an hour
- Contract
- Experience working with individuals with disabilities
- Mid-level
- Driver's License
- Flexible schedule
Quick Apply
10d
Telephonic Care Manager (RN) - Adult Care Management
UPMC —Pittsburgh, PA
- $34.49 - $56.83 an hour
- Full-time
- Nursing
- RN License
- Computer literacy
Utilization Review Manager - PRN
Assurance Health System, LLC —Remote
- Part-time
- Remote
- Psychiatry
- RN License
- Mid-level
- Health insurance
- 401(k)
Quick Apply
1d
Case Manager
Stanford Health Care Tri-Valley —Pleasanton, CA
- $70.57 - $95.29 an hour
- Full-time
- Acute care
- Nursing
- RN License
Clinical Nurse Manager - Maternal Newborn - Children's Hospital
University of Missouri Health Care —Columbia, MO
- $108,971 - $177,590 a year
- Full-time
- Nursing
- RN License
- Bachelor of Science
- Paid holidays
- Health insurance

I want to receive the latest job alert for Manager Nursing

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Claims - Care Manager, RN, Claims

Wellcove
Remote

Quick Apply

Job Details

Full-time

Qualifications

RN License

Full Job Description

Who We Are
Wellcove has been recognized as the nation’s leading full-service senior market solutions provider for over 25 years. Our solutions span the insurance senior market sector, focusing on long-term care and Medicare Supplement plans. However, we don’t stop there. Wellcove also addresses challenges faced in accident & health, disability, and supplemental health insurance programs.

Our team provides individuals and their families with peace of mind knowing their insurance needs will be met in a thoughtful, efficient manner. We are able to do this because of our dedicated associates, innovative solutions, and state-of-the-art technology.

We are seeking an experienced Registered Nurse (RN) to serve as a Care Manager supporting Long Term Care (LTC) insurance claims. This individual contributor role is responsible for conducting comprehensive clinical eligibility reviews to determine whether policyholders meet the benefit eligibility requirements outlined in their LTC policy.
The Care Manager, RN will complete and document Chronically Ill Certifications (CICs) and develop Plans of Care (POCs) for initial claims and ongoing recertifications, ensuring determinations are clinically sound, and policy aligned.

Key Responsibilities

Perform detailed clinical reviews of LTC claim files to determine eligibility in accordance with policy provisions and regulatory requirements.
Assess Activities of Daily Living (ADLs), cognitive impairment, diagnoses, comorbidities, and level of care needs.
Review medical records, Minimum Data Set (MDS) assessments, facility documentation, home health records, daily visit notes, and supporting claim forms.
Determine whether the insured meets the policy definition of Chronically Ill.
Prepare and document Chronically Ill Certifications (CICs) and individualized Plans of Care (POCs) for initial approvals and recertifications.
Clearly document clinical rationale to support benefit determinations.
Collaborate with Claims, Eligibility, and Customer Service teams to obtain additional documentation when necessary.
Maintain knowledge of LTC policy language, benefit triggers, and regulatory requirements.

Qualifications

Active, unrestricted Registered Nurse (RN) license required.
Clinical experience in long-term care, home health, geriatrics, case management, or utilization review preferred.
Experience reviewing medical records and assessing functional and cognitive impairment.
Knowledge of LTC insurance benefit triggers, ADL requirements, and chronically ill certification standards preferred.
Strong clinical judgment, critical thinking, and documentation skills.
Ability to manage multiple cases and meet turnaround expectations.

At Wellcove, we strive to create an inclusive culture for all. We understand the importance of listening and incorporating various perspectives at every level of service. Our company does not discriminate based on gender identity, race, sexual orientation, age, religion, or disability.

Quick Apply

Refine Your Search

Manager Nursing jobs

Claims - Care Manager, RN, Claims

Care Manager, Concurrent Review (Remote)

Clinical Services Assistant Manager

Case Manager / RN

Remote Behavioral Registered Nurse (RN)– Remote Care Manager

Remote Case Manager (RN)

Clinical Case Manager-RN

RN Case Manager

Manager, inpatient Nursing Behavior Health

Virtual Nurse Case Manager/Neurology (12-9p EST)

Social Work Case Manager

Clinical Case Manager (Wound Care)

Care Continuity & Patient Retention Manager

Case Manager, Registered Nurse (Oncology experience required)

RN/LVN SNP Telephonic Case Manager I

Case Manager-Field Coordinator

Telephonic Care Manager (RN) - Adult Care Management

Utilization Review Manager - PRN

Case Manager

Clinical Nurse Manager - Maternal Newborn - Children's Hospital

I want to receive the latest job alert for Manager Nursing

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected