Nurse Case Manager - Remote (Part-Time)

Remote Part Time $40.00 - $50.00 / Hourly Posted: 12/2/25, 3:58 PM - Contact: David James Description Nurse Case Manager – Stop Loss | Remote & Part-time Are you a nurse 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 help us evaluate complex claims and guide cost-effective care solutions. What You'll Do: Review and analyze high-cost medical claims to assess appropriateness, necessity, and cost-effectiveness of treatment. 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 a win-win solution. Provide clinical insights that helps our underwriting team make informed decisions on group coverage. What We're Looking For: Medical Case Manager with 5+ years of hands-on medical experience. Hospital, clinical, or cost containment background—NOT working for insurance carrier 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: Hospital nurses seeking remote part-time work; Semi-retired nurses; Stay-at-home parents with nursing backgrounds; Cost containment or utilization review nurses ready for a change 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