Case Management Nurse - OB/Maternity Experience

About Innovative Care ManagementIn an increasingly complex healthcare environment, ICM remains focused on something essential: putting people at the center of every decision. We are dedicated to ensuring that members and health plans feel genuinely seen, heard, and supported throughout their care journey.We serve clients nationwide with a values-driven approach that blends compassion, clinical expertise, and operational excellence. Our core values: Kindness, Personal Responsibility, a Can-Do Attitude, and Humble Confidence, shape how we work, how we lead, and how we care for those we serve.As we grow, we welcome individuals who share our belief that healthcare should be effective, compassionate, and truly centered on people.About The RoleThe Case Manager Nurse plays a critical role in supporting members with complex or chronic conditions by providing proactive, telephonic case management grounded in a whole-person approach. This role focuses on reducing avoidable utilization, improving care coordination, and helping members navigate the healthcare system with confidence and clarity.As a trusted clinical resource, the Case Manager Nurse partners closely with members, providers, and health plans to assess needs, develop individualized care plans, and advocate for appropriate, cost-effective services. In addition to core case management responsibilities, this role also supports utilization review activities when needed, contributing to timely medical necessity determinations and continuity of care.This position is ideal for an experienced RN who brings strong clinical judgment, excellent communication skills, and a passion for improving outcomes for high-need populations in a collaborative, remote care management environment.This is a fully remote role. Candidates must reside in Iowa, Arizona, or Idaho.Schedule: This position works four 10-hour shifts per week and must be able to support ICM’s standard operating hours of 8:00 AM–5:00 PM Pacific Time. Specific shift times may vary based on business needs and the candidate’s time zone. For example, a candidate residing in Iowa may have a shift that begins earlier in Central Time, such as 7:00 AM or 8:00 AM CT, depending on coverage needs.What You'll DoPatient Identification & AssessmentIdentify members who would benefit from case management using claims data, referrals, and clinical recordsReview referrals for clinical appropriateness using sound judgment and program parametersConduct comprehensive assessments of medical, behavioral, and social needs using a whole-person approachCare Planning & CoordinationDevelop individualized care plans based on patient needs, barriers, and goalsCoordinate care across the continuum, including primary care, specialists, behavioral health, and community-based resourcesFacilitate clear communication between patients, providers, caregivers, and health plans to support safe transitions of care and adherence to treatment plansClinical Case Management & AdvocacyProvide telephonic case management for high-utilization patients with complex or chronic conditionsUse best practices in chronic disease management, motivational interviewing, and patient educationAdvocate for timely, appropriate, and cost-effective care while balancing clinical judgment with plan guidelinesSupport patients in navigating healthcare systems and overcoming barriers to careUtilization Review & Medical Decision-MakingEvaluate precertification requests using evidence-based criteria and plan-specific guidelinesReview ongoing inpatient stays and make length-of-stay determinations as appropriatePartner with Appeals & Denials and/or in-house providers to support complex clinical decisionsDocumentation, Reporting & ComplianceDocument all assessments, interventions, communications, and determinations thoroughly and accurately in ICM systemsProvide client-facing reports summarizing interventions, outcomes, and estimated cost savingsEnsure compliance with internal policies, regulatory requirements, and HIPAA standardsCollaboration, Leadership & Continuous ImprovementPartner with other clinical teams across ICM to remove care barriers and improve patient outcomesServe as a senior clinical resource, contributing to program development, cross-training, and process improvementStay current on best practices, regulations, and clinical guidelines related to case managementParticipate in training, quality assurance initiatives, and professional developmentRequiredWhat You BringActive, unrestricted Registered Nurse (RN) license in good standingAssociate’s or Bachelor’s degree in Nursing5+ years of clinical nursing experienceOB, maternity, labor and delivery, postpartum, maternal-child health, or related nursing experienceStrong knowledge of chronic disease management, utilization management, and social determinants of healthExperience managing complex, high-utilization patient populationsExcellent written and verbal communication skills with empathy, professionalism, and emotional intelligenceStrong organizational skills with the ability to manage multiple priorities independentlySound clinical judgment and confidence navigating complex or sensitive situationsComfort working independently in a remote environment with strong accountability and follow-throughAbility to manage confidential information in compliance with HIPAAMust reside in Iowa, Arizona, or IdahoAbility to work four 10-hour shifts per week and support coverage during ICM’s standard operating hours of 8:00 AM–5:00 PM Pacific TimeEven Better If You HaveCase management or utilization certifications (e.g., CCM, CPUR, CPHM)Experience with maternity case management, high-risk pregnancy care coordination, or perinatal care managementExperience in case managementExperience in a TPA or self-funded health plan environmentKnowledge of health insurance regulations and utilization management processesExperience using medical necessity criteria and utilization review toolsExperience with EMRs and care management platformsMulti-state licensure