Senior Case Manager (RN)

📋 Description

• Review claims, prior auth requests, and ADT (admission/discharge/transfer) data to identify members who would benefit from case management
• Conduct clinical assessments and build individualized care plans with members
• Coordinate directly with PCPs, specialists, hospitals, and post-acute providers to ensure care plans are executed and gaps are closed
• Support members through complex episodes — new diagnoses, hospitalizations, transitions of care, and chronic condition management
• Partner with our utilization management workflows on medical necessity questions and appropriate level of care
• Help us build the playbook: contribute to protocols, escalation pathways, and the tooling we use to do this work well

🎯 Requirements

• Active, unrestricted RN license; multi-state compact license strongly preferred
• 5+ years of clinical nursing experience, with relevant experience in case management, utilization management, care coordination, or discharge planning
• Comfort reading and interpreting claims data, prior auth criteria (MCG/InterQual), and clinical documentation
• Strong communication skills — you can hold your own with a skeptical specialist and also meet a member where they are
• Self-directed; you can run your panel without someone over your shoulder
• Comfort working in a fast-moving environment where processes are still being built

🎁 Benefits

• High ownership: You’ll get real responsibility from day one—our high-trust team empowers you to run with big problems and shape core parts of the company.
• Join an important mission: Your work directly influences how people access care and improves lives at scale.
• Growth & expansion: We’re moving fast, and as we grow, your scope will grow with us—new challenges, bigger opportunities, and rapid career velocity.
• Apply AI to a problem that matters: Instead of optimizing ads or cutting labor costs, you’ll use AI to fundamentally reimagine how people get healthcare.
• High pace, high collaboration: We operate with velocity, first-principles thinking, and a team that works closely, openly, and with ambition.