Remote Nurse Case Manager Jobs: How to Get Started

What does a remote nurse case manager do?

One of the most important things to understand about remote case management is that the role may vary significantly from one setting to another. A nurse case manager working remotely for a hospital will have a very different day than one working for a health plan or insurance company. And those differences will shape how much phone time you have, what type of patients you follow, and what skills you’ll gain for future roles.

Remote hospital-based case managers are involved in many different aspects of the patient care team (for both inpatient and outpatient), involving utilization review, discharge planning, care coordination, and finding available community resources for patients after discharge from the hospital.

They spend most of their day coordinating discharges and making sure patients have everything in place once they leave the hospital. That means fielding calls and messages from providers, bedside nurses, family members, home health agencies, skilled nursing facilities, and vendors, such as wound vac companies. You’re also in close contact with insurance payers, helping to ensure that any patient authorizations are approved.

A significant part of the job is anticipating potential barriers early, so that when a patient is medically cleared, the transition out of the hospital can occur smoothly. In a typical day, you may be arranging home health services, booking follow-up appointments, checking on equipment deliveries, or coordinating transportation. It’s a lot of moving pieces in a fast-paced environment, but the goal remains the same: ensuring the patient has what they need once they leave the hospital.

Remote insurance or health plan case managers focus on ongoing member telephonic outreach and coordination. Depending on the program, you might be assigned a caseload of members to follow, or you may work more on structured outreach lists. These roles usually have quotas and KPIs that track call activity, engagement, and quality outcomes. Some teams use auto-dialers or enrollment scripts, while others allow for more clinical judgment in conversations.

Day to day, a health plan case manager might look like:

• Complete intake calls and follow-up assessments with members
• Reinforce preventive guidelines and provide education for chronic conditions
• Coordinate referrals across providers, pharmacies, and community services
• Work closely with utilization review teams to resolve authorizations or denials
• Address social determinants of health, like connecting members to food, housing, or transportation support

Both hospital-based and health plan remote case manager jobs can be a great path into utilization review or utilization management remote jobs because you’ll gain experience with medical necessity guidelines, benefit navigation, preventive guidelines, population health, and assessing social determinants of health.

You can get an idea of which remote jobs will offer the opportunity to learn these skills by looking for keywords such as MCG or InterQual (often listed as a preferred qualification) in the job description. These keywords indicate the company expects you to work with the same guidelines/criteria used in UR/UM roles. That kind of exposure can make it easier to transition to UR roles later on!

Hybrid roles split your time between working remotely at home and either reporting to the office or visiting patients face-to-face. It’s important to ask about this during your recruiter screening interview so you understand what’s expected. A job description that lists a driver’s license requirement can sometimes signal the need for field visits, although in some cases it may simply mean occasional onsite meetings or that a specific state residency is required.

Because the role can look so different depending on the employer and specialty, it’s smart to go into your screening or interview with a list of questions ready. Ask about the call expectations, how the caseload is managed, what systems are used, and what skills you’ll gain that could set you up for your next role. Always clarify during the recruiter screening so you know exactly what the day-to-day will look like. For a list of additional questions to ask in your interview, download the Free Remote Nursing Jobs Getting Started Guide.

Clinical experience for remote nurse case managers

Most employers hiring for remote nurse case manager jobs want at least two years of bedside nursing experience, although you may come across a rare one willing to accept less. Med-surg, ER, ICU, and step-down units are common because they see a broad mix of diagnoses, medications, and discharge scenarios. That range makes it easier to educate patients and spot issues during follow-up calls.

Specialty clinical knowledge is also desired for remote case managers. Roles can be focused on pediatrics, neonatal care, oncology, workers’ compensation, disability, SNF, behavioral health, hospice, and home health. There’s really something for everyone when it comes to case manager roles! Sometimes, job descriptions will clearly state the specialty experience they are looking for, and other times, it’s more generic. Pediatric and neonatal postings tend to close quickly because they are highly sought after and in high demand. Recently, there has been an increase in the number of openings that are seeking nurses with experience in behavioral health or home health.

Case management remote jobs often prefer a compact license, allowing you to work across multiple states and provide care to more patients. If you live in a non-compact state, do not count yourself out! Hospitals and regional systems in your state often hire remote or hybrid case managers who only need a single state license. Nurse who are eligible for a compact license can apply for an endorsement license in non-compact states to enhance their resume and gain eligibility for more remote jobs.

If you want to use case management as a stepping stone to a job in utilization review or management, pay close attention to the job description. Look for the description to mention MCG or InterQual, which means you’ll be working with the same criteria used in UR/UM and gaining experience that makes it easier to pivot to those roles later on.

How to include your background on a case management resume

Once you have enough clinical nursing experience, the next step is making sure it shows up clearly on your resume. Employers skim resumes quickly, so you want the transferable skills they care about front and center. Remember to quantify your work experience by including relevant metrics whenever possible.

1. Start with patient education. Show where you taught patients about medications, recovery instructions, or lifestyle changes, and how you used teach-back to confirm understanding. Case managers spend a lot of time on education, so this is a skill that will likely be in most CM job descriptions.
2. Discharge planning and coordination are other areas to emphasize. Suppose you’ve worked with social workers, home health, or community resources to help patients transition safely. Did you help assess social determinants of health (SDOH) for patients? In that case, those are the types of transferable skills and knowledge hiring managers look for in new nurses to train for case management jobs.
3. Experience with chronic conditions is also important. Employers know that nurses who’ve worked with patients managing diabetes, heart disease, COPD, or cancer already understand the complexity that comes with ongoing care.
4. Comfort with electronic health records (& any other tech software listed in the job description) should also be on your resume. Remote case managers spend a lot of time simultaneously speaking to patients, navigating EHRs, and documenting, so employers look for nurses who can manage those tasks smoothly..
5. Finally, include any exposure to medical necessity criteria, denial prevention, or transitions of care. Even a small amount of experience in these areas shows you’re familiar with the administrative side of nursing and ready for the next step if you want to move toward utilization review or management later.

If you’d like a deeper dive into resumes for remote nursing jobs, here are a few more posts on that topic:

• Ultimate Guide to an ATS-Friendly Remote Nurse Resume Template
• How to Craft the Perfect Resume for Landing Remote Nursing Jobs
• How to Get a Remote Nursing Job When You Keep Getting Rejected

Is Remote Case Management a Good Career Move for Nurses?

For many nurses, case management has become one of the most effective ways to transition away from bedside work without abandoning patient care entirely, whether remotely or onsite. One of the reasons many nurses end up liking case management is that it’s a role where you can continue to use your nursing judgment while still having regular patient interaction. Some other roles that are similar to case management but may offer different day-to-day work patterns are care coordinators/navigators and patient advocates. You can read more about different types of remote nursing roles in this blog post.

Pay for CM nurses is competitive compared to other remote nursing jobs, and recent surveys from the Case Management Institute show salaries are trending upward, with more case managers earning above six figures than ever before (after gaining experience). Just as important, according to the CMI survey, case managers reported higher job satisfaction than the national average, which speaks volumes in today’s burned-out nursing environment.

Salaries also vary widely across the United States for remote nursing case manager jobs. For example, the salary offered to a nurse based in Texas will differ significantly in pay compared to the same role in another state, such as California, Illinois or New York, much like what we see with drastically different bedside nursing salaries.

Some nurses find their long-term home in case management, while others use it as a stepping stone to roles in utilization review, quality, or medical policy. Either way, it’s a remote nursing job worth keeping on your list if you want to break into a role that offers stability now and opportunities for continued career growth into a variety of other remote nursing roles later.