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 clinical or medical team. Mandatory Requirements
• NCLEX-RN certification is mandatory.
• B.
Sc. Nursing, Post Basic B.
Sc. Nursing, or M.
Sc. Nursing.
• Valid nursing registration from the appropriate Nursing Council.
• Strong clinical knowledge and understanding of medical terminology.
• Experience in bedside nursing, case management, clinical review, medical-record review, claims review, utilization management, or healthcare operations.
• Good understanding of diagnoses, medications, treatment plans, and patient-care documentation.
• Robust written and verbal English communication skills.
• Comfortable working in US shifts or night shifts.
• Good computer skills and experience working with electronic medical records or healthcare applications.

📌 Case Management Nurse (Chennai)
🏢 Alight Solutions
📍 Chennai