Job Title: Nurse Case Manager

Location: Bangalore / Work from Home, as applicable
Employment Type: Full time
Shift: US Shift / Night Shift, as per business requirements
Mandatory Certification: NCLEX-RN certification

Job Summary
We are looking for an experienced Nurse Case Manager with active or completed NCLEX-RN certification and strong clinical nursing knowledge. The candidate will be responsible for reviewing medical records, assessing patients’ healthcare needs, coordinating care plans, supporting utilization and claims-related reviews, and communicating with members, healthcare providers, and internal teams.
The ideal candidate should have experience in clinical nursing, medical-record review, clinical claims, healthcare operations, case management, utilization management, or a related healthcare process.
Key Responsibilities
• Review patients’ medical records, diagnoses, treatment plans, medications, and clinical history.
• Assess members’ healthcare needs and identify appropriate care-management interventions.
• Develop, document, and monitor individualized care plans.




• Coordinate with physicians, hospitals, healthcare providers, members, and internal teams.
• Conduct telephonic or virtual assessments and provide appropriate clinical guidance.
• Educate members regarding treatment plans, medication adherence, follow-up care, and available healthcare resources.
• Monitor patient progress and update care plans based on clinical requirements.
• Review clinical claims and supporting medical documentation when required.
• Identify gaps in care, potential health risks, and opportunities for improved clinical outcomes.
• Maintain complete and accurate case notes in accordance with established procedures and quality standards.
• Ensure compliance with clinical protocols, confidentiality requirements, and organizational policies.
• Meet applicable productivity, quality, and turnaround-time expectations.
• Escalate complex or high-risk cases to the appropriate clin

📌 Case Management Nurse (Chennai)
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