Peak Care Manager

📋 Description

• Participate in development, implementation, and oversight of care management programs.
• Perform utilization management reviews per clinical criteria and policies.
• Manage triage of member self-referrals to care management services.
• Identify high-risk members using HRA and other data sources.
• Connect members to in-network providers, resources, and support programs.
• Identify barriers to optimal outcomes and develop interventions.

🎯 Requirements

• Current Registered Nurse (RN) license in the service state or a multi-state RN license via eNLC.
• At least 3 years of healthcare clinical experience.
• Bachelor’s degree in Nursing preferred; ASN acceptable; BSN expected to complete within 3 years for
• Experience managing Medicare and/or Medicaid populations preferred.
• At least 2 years of care management experience is preferred.
• Working knowledge of InterQual and/or Milliman Care Guidelines.

🎁 Benefits

• Remote work: Full-time position performed remotely within the United States.
• Full-time schedule: 40 hours/week, exempt.
• Meaningful clinical impact through care coordination and quality-focused interventions.
• Professional development in care management, utilization management, quality improvement
• Collaborative environment with medical management, clinical, quality, and care management
• Mission-driven work to improve community health and financial outcomes.