Case Manager Expert (Remote, Contract)

What You'll Do7

• Construct realistic care coordination scenarios that begin at admission and continue through post acute placement.
• Draft reference answers that spell out the reasoning behind every level of care determination.
• Review model responses for clinical appropriateness and accuracy on benefit questions.
• Call out care plans that read well on paper yet would strand a patient or set off a payer denial.
• Tailor scenarios to your own specialty area so the evaluations reflect real professional practice.
• Set your own weekly hours, with a floor of 10 and no ceiling, and scale output up or down as your schedule allows.
• Write care plan logic clearly enough that another case manager can follow the trail without asking questions.

Requirements8

• An active RN or LCSW license, or a CCM certification.
• At least 2 years of case management practice in a hospital, payer, or community setting.
• Demonstrated depth in discharge planning, utilization review, or complex care coordination.
• Clear written English suitable for documenting care plans and level of care decisions.
• Availability of 10 hours per week or more.
• CCM or ACM certification preferred.
• Familiarity with InterQual or MCG criteria preferred.
• Payer side utilization management or appeals background preferred.

Who Should Apply

Licensed case managers with 2 or more years in a hospital, payer, or community setting who can explain a level of care decision in writing and spot the plan that looks fine but fails the patient. CCM or ACM holders with InterQual, MCG, or payer appeals experience fit best.

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