Job Description
This is a full-time role, with a preference for candidates based in Atlanta; remote candidates will be considered.
About Curae
Curae is a healthcare revenue cycle technology and services company focused on improving access to care and simplifying complex financial workflows. Our platform supports healthcare organizations by combining technology, operational expertise, and financial precision to deliver better outcomes for providers and patients.
Position Overview
We are seeking an experienced Nurse Case Manager / Utilization Manager to perform comprehensive medical record reviews to determine patient appropriateness for an insurance-related program. This role centers on holistic clinical assessment of the entire patient chart—including diagnoses, problem lists, provider notes, prior encounters, medications, and treatment history—to evaluate true clinical complexity, anticipated medical needs, and alignment with program eligibility criteria.
While ICD-10 codes are reviewed as part of the process, this role requires the ability to synthesize information across the full medical record and apply advanced clinical judgment beyond surface-level coding.
Key Responsibilities
Comprehensive Medical Record Review & Clinical Assessment
• Conduct end-to-end reviews of patient medical records, including diagnoses, problem lists, provider notes, prior visits, medications, and treatment plans.
• Evaluate whether the full clinical record accurately reflects disease burden, acuity, comorbidities, and overall patient complexity.
• Identify gaps, inconsistencies, or ambiguities across documentation that impact clinical understanding or eligibility determination.
• Use ICD-10 codes as a reference point while validating diagnoses against the broader clinical narrative.
• Request additional documentation or clarification when the medical record does not sufficiently support clinical conclusions.
Utilization Review & Eligibility Determination
• Analyze submitted diagnoses for alignment with internal eligibility thresholds and criteria.
• Assess anticipated medical needs, utilization risk, and potential cost drivers associated with each diagnosis.
• Document approval or denial decisions with clear, defensible clinical rationale.
• Collaborate with cross-functional partners to refine and improve internal scoring and eligibility criteria based on clinical findings.
Clinical Needs Assessment & Utilization Risk Evaluation
• Assess anticipated medical utilization, treatment intensity, and potential cost drivers based on longitudinal chart review.
• Evaluate potential complications, disease progression, and long-term care considerations.
• Determine whether documented conditions and treatments align with program eligibility thresholds and intent.
• Apply independent clinical judgment to approve or deny cases, documenting a clear and defensible rationale.
Quality Assurance & Documentation Integrity
• Ensure accuracy, consistency, and integrity across all clinical reviews and determinations.
• Identify patterns of miscoding, vague documentation, or incomplete clinical submissions.
• Maintain thorough review logs and standardized documentation to support audit readiness and quality improvement.
Required Qualifications
• Active Registered Nurse (RN) license.
• Required: 5+ years of experience in one or more of the following: Clinical Documentation Integrity (CDI), Case Management, Utilization Review / Utilization Management, Acute-care nursing with clinical review responsibilities
• Strong understanding of how diagnoses, provider documentation, medications, and treatment history interrelate within the medical record, including working knowledge of ICD-10 coding principles.
• Demonstrated ability to interpret clinical data beyond diagnosis codes alone.
• Excellent critical-thinking, analytical, and independent decision-making skills.
• Strong written and verbal communication skills, with the ability to clearly document clinical rationale.
Preferred Qualifications
• Strongly Preferred: 3+ years of oncology and/or infusion nursing experience.
• Preferred: 3+ years of transplant and/or surgical nursing experience.
• Certified Clinical Documentation Specialist (CCDS) or equivalent certification.
• Prior experience in remote clinical review, telehealth triage, or virtual care settings.
• Experience reviewing clinical documentation for reimbursement, utilization, risk scoring, or insurance eligibility purposes.
Position Details
• Employment Type: Full-Time
• Location: Atlanta (Preferred) or Remote
• Primary Function: Clinical evaluation of patient cases to determine program eligibility
Why Curae
• Mission-driven work focused on access to care
• Opportunity to influence multiple products and workflows
• Collaborative, cross-functional environment
• Room to grow as the platform and organization scale
Report this listing
About Curae
Curae is a healthcare revenue cycle technology and services company focused on improving access to care and simplifying complex financial workflows. Our platform supports healthcare organizations by combining technology, operational expertise, and financial precision to deliver better outcomes for providers and patients.
Position Overview
We are seeking an experienced Nurse Case Manager / Utilization Manager to perform comprehensive medical record reviews to determine patient appropriateness for an insurance-related program. This role centers on holistic clinical assessment of the entire patient chart—including diagnoses, problem lists, provider notes, prior encounters, medications, and treatment history—to evaluate true clinical complexity, anticipated medical needs, and alignment with program eligibility criteria.
While ICD-10 codes are reviewed as part of the process, this role requires the ability to synthesize information across the full medical record and apply advanced clinical judgment beyond surface-level coding.
Key Responsibilities
Comprehensive Medical Record Review & Clinical Assessment
• Conduct end-to-end reviews of patient medical records, including diagnoses, problem lists, provider notes, prior visits, medications, and treatment plans.
• Evaluate whether the full clinical record accurately reflects disease burden, acuity, comorbidities, and overall patient complexity.
• Identify gaps, inconsistencies, or ambiguities across documentation that impact clinical understanding or eligibility determination.
• Use ICD-10 codes as a reference point while validating diagnoses against the broader clinical narrative.
• Request additional documentation or clarification when the medical record does not sufficiently support clinical conclusions.
Utilization Review & Eligibility Determination
• Analyze submitted diagnoses for alignment with internal eligibility thresholds and criteria.
• Assess anticipated medical needs, utilization risk, and potential cost drivers associated with each diagnosis.
• Document approval or denial decisions with clear, defensible clinical rationale.
• Collaborate with cross-functional partners to refine and improve internal scoring and eligibility criteria based on clinical findings.
Clinical Needs Assessment & Utilization Risk Evaluation
• Assess anticipated medical utilization, treatment intensity, and potential cost drivers based on longitudinal chart review.
• Evaluate potential complications, disease progression, and long-term care considerations.
• Determine whether documented conditions and treatments align with program eligibility thresholds and intent.
• Apply independent clinical judgment to approve or deny cases, documenting a clear and defensible rationale.
Quality Assurance & Documentation Integrity
• Ensure accuracy, consistency, and integrity across all clinical reviews and determinations.
• Identify patterns of miscoding, vague documentation, or incomplete clinical submissions.
• Maintain thorough review logs and standardized documentation to support audit readiness and quality improvement.
Required Qualifications
• Active Registered Nurse (RN) license.
• Required: 5+ years of experience in one or more of the following: Clinical Documentation Integrity (CDI), Case Management, Utilization Review / Utilization Management, Acute-care nursing with clinical review responsibilities
• Strong understanding of how diagnoses, provider documentation, medications, and treatment history interrelate within the medical record, including working knowledge of ICD-10 coding principles.
• Demonstrated ability to interpret clinical data beyond diagnosis codes alone.
• Excellent critical-thinking, analytical, and independent decision-making skills.
• Strong written and verbal communication skills, with the ability to clearly document clinical rationale.
Preferred Qualifications
• Strongly Preferred: 3+ years of oncology and/or infusion nursing experience.
• Preferred: 3+ years of transplant and/or surgical nursing experience.
• Certified Clinical Documentation Specialist (CCDS) or equivalent certification.
• Prior experience in remote clinical review, telehealth triage, or virtual care settings.
• Experience reviewing clinical documentation for reimbursement, utilization, risk scoring, or insurance eligibility purposes.
Position Details
• Employment Type: Full-Time
• Location: Atlanta (Preferred) or Remote
• Primary Function: Clinical evaluation of patient cases to determine program eligibility
Why Curae
• Mission-driven work focused on access to care
• Opportunity to influence multiple products and workflows
• Collaborative, cross-functional environment
• Room to grow as the platform and organization scale
Report this listing
💡 Quick Summary
Seeking a career-building opportunity? The Case Management Nurse position is now open for candidates interested in the Nurse / Compounder Jobs sector. This role in Atlanta offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Nurse / Compounder Jobs is a plus.
