Nurse Case Manager - Remote (Part-Time)

Remote Part Time $40.00 - $50.00 / Hourly Posted: 12/15/25, 5:09 PM - Contact: David James Description Nurse Case Manager – Stop Loss | Remote & Part-time Are you an RN looking for flexible, remote work that leverages your clinical expertise? We're a growing insurance organization specializing in stop-loss insurance, seeking an experienced Nurse Case Manager to review complex cases, predict potential surgery and treatment costs, and provide predictive pricing analysis to guide underwriting decisions on premium allocation. What You'll Do: Review and analyze high-cost medical claims to assess appropriateness, necessity, and cost-effectiveness of treatment. Predict potential costs for surgeries and treatments to support accurate pricing and risk assessment. Collaborate with underwriters to evaluate potential stop-loss clients and understand group risk profiles. Identify alternative treatment options and cost-saving opportunities without compromising patient care quality. Leverage your medical network and resources to navigate hospital systems, negotiate solutions, and facilitate optimal outcomes. Act as a trusted advisor and collaborator, working diplomatically with providers, claimants, and internal teams to find win-win solutions. Provide clinical insights that help our underwriting team make informed decisions on group coverage. Hit the ground running with limited training, providing immediate guidance to underwriters based on your stop-loss expertise. What We're Looking For: Medical Case Manager with 5+ years of hands-on medical experience. Stop-loss insurance experience strongly preferred – you should be able to guide underwriters from day one with limited training. Part-time RN with hospital (especially telephonic cost containment), clinical, or cost containment background, preferably with experience working for an insurance carrier, TPA, or MGU. Deep understanding of medical billing, treatment protocols, and healthcare costs. Strong professional network and ability to navigate hospital politics tactfully. Problem-solver who can identify creative alternatives that balance patient care with financial realities. Excellent communication skills and ability to explain complex medical information to non-clinical stakeholders. Self-motivated and comfortable working independently in a remote environment. Ideal Candidates Include: Nurse case managers with stop-loss insurance experience Telephonic cost containment nurses from hospital settings seeking remote part-time work Semi-retired nurses with stop-loss or insurance backgrounds looking to stay engaged in the field Stay-at-home parents with nursing and stop-loss experience wanting part-time work Veterans with medical training transitioning to civilian healthcare roles Cost containment or utilization review nurses from insurance carriers, TPAs, or MGUs interested in part-time work About Criterion Executive Search, Inc. For 44 years Criterion Executive Search has been recognized as one of the nation’s leading executive staffing and recruiting firms. As one of Tampa, FL first recruiting & staffing agencies we have been privileged to work with leading companies throughout the state of Florida. Those same strategic partnerships have allowed us to perfect our personalized, life-cycle approach to placing the ideal candidates with their ideal companies. Our innovative individualized placement strategies allow us to match Insurance professionals with companies throughout the country, and beyond. Each of our job placement specialists has a minimum of two years in the recruiting industry and an average of nearly 15 years of experience. Each recruiter has their own, personal, and direct experiences within their specialization. You may expect complete confidentiality at all times during the hiring process; a key element to the success of our business. In today's age we understand that our client's privacy is of the utmost importance. Contact the Criterion Executive Search office to speak with a recruiter about this job now or find out more about other job placement opportunities. All applicants applying for U.S. job openings must be authorized to work in the United States. All applicants applying for Canadian job openings must be authorized to work in Canada. ©2025 Criterion Executive Search. An Equal Opportunity Employer. Veteran Owned. Job Id Number : 11258 Staffing Industry : Insurance Contact David James in our Tampa, FL office for questions or to apply for the Nurse Case Manager - Remote (Part-Time) job today; Work Location: Remote Apply tot his job Apply To this Job