Nurse Care Manager I – Virtual/Hybrid (Puerto Rico)

About the role

This position is a virtual‑first, full‑time Nurse Care Manager I based in Puerto Rico. You will work rotating 8‑hour shifts between 8:30 am and 8:30 pm ET, Monday through Friday, with occasional weekend or holiday coverage as operational needs dictate.

Key responsibilities

• Assess medical necessity of inpatient admissions, extensions of stay, outpatient and out‑of‑network services.
• Partner with physician reviewers and medical directors to interpret care appropriateness and guide interventions.
• Collaborate with providers to identify consumer needs, plan proactive discharges, and ensure seamless transitions.
• Conduct clinical assessments, develop individualized care plans, and set measurable health goals.
• Monitor and evaluate the effectiveness of care plans, adjusting strategies as required.

Required profile

• High school diploma or equivalent plus a minimum of three years acute‑care clinical experience, or an equivalent combination of education and experience.
• Current, active, unrestricted RN license in the applicable state(s); multi‑state licensure if services are provided across states.
• Ability to work virtually with occasional in‑person training sessions.

Required skills

• NCLEX certification.

What we offer

• Maximum flexibility through a virtual work model.
• Opportunities to improve health outcomes for complex, chronic‑care members.
• Supportive bilingual (English/Spanish) call‑center environment.