Nurse Care Manager I

About the role

The Nurse Care Manager I collaborates with healthcare providers and consumers to deliver personalized health management for members with complex and chronic needs. This virtual‑first position is based in Puerto Rico and offers flexible scheduling while ensuring essential in‑person training.

Key responsibilities

• Assess medical necessity of inpatient admissions, extensions of stay, outpatient and out‑of‑network services to ensure high‑quality, cost‑effective care.
• Partner with physician reviewers and medical directors to interpret care appropriateness and develop intervention plans.
• Collaborate with providers for early discharge planning and conduct clinical assessments to create individualized care plans.
• Monitor and evaluate care plan effectiveness, adjusting as needed to achieve optimal health outcomes.

Required profile

• Current, active, unrestricted RN license in the applicable state(s); multi‑state licensure required if serving multiple states.
• Minimum of 3 years acute‑care clinical experience (or equivalent education/experience).
• High school diploma or equivalent; BSN or AS in nursing strongly preferred.
• Fully bilingual in English and Spanish with proficient reading, writing, and speaking abilities.

Required skills

• Clinical assessment and care planning for complex, chronic conditions.
• Knowledge of discharge planning and home health processes.
• Case management principles and coordination with multidisciplinary teams.

What we offer

• Hybrid/virtual work model with flexibility and required in‑person training.
• Competitive total rewards including medical, dental, vision, PTO, 401(k) match, stock purchase plan, and wellness programs.
• Opportunities for professional growth within a Fortune 25 healthcare company.