Job Title: RN Case Manager - Medicare Advantage (Telephonic, Hybrid)
Job Description
This role offers an experienced RN the opportunity to provide telephonic case management for Medicare Advantage members in Florida. You will coordinate care, develop individualized care plans, and support members through comprehensive assessments and ongoing follow-up, using Athena EMR and other digital tools in a fast-paced, hybrid work environment.
Responsibilities
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Perform telephonic case management for Medicare Advantage members residing in the state of Florida.
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Conduct comprehensive assessments of members' health status, needs, and risks to inform individualized care plans.
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Develop, implement, and update care plans that address medical, behavioral, and social needs, ensuring appropriate interventions and services.
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Perform care coordination activities, including arranging services, coordinating with providers, and facilitating transitions of care across hospital, acute care, home health, and hospice settings.
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Manage new referrals by reviewing clinical information, determining eligibility and needs, and initiating case management services in a timely manner.
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Build and maintain new and existing cases in Athena EMR, ensuring accurate and thorough documentation of assessments, care plans, interventions, and outcomes.
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Call members regularly to monitor progress, reinforce care plans, provide education, and address questions or concerns.
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Handle a caseload of at least 73 members while maintaining high-quality standards, timely follow-up, and regulatory compliance.
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Utilize triage skills to prioritize member needs, escalate concerns appropriately, and support utilization management activities when needed.
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Use strong computer and data entry skills to document all interactions, update records, and generate reports in Athena EMR and Microsoft Office applications.
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Collaborate with interdisciplinary care teams, including physicians, nurses, and other healthcare professionals, to ensure coordinated, patient-centered care.
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Deliver excellent customer service by communicating clearly and compassionately with members, caregivers, and providers.
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Work efficiently in a fast-paced, high-acuity environment while adhering to organizational policies, clinical guidelines, and best practices in case management.
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Demonstrate a genuine commitment to case management as a professional discipline and maintain focus on member outcomes and satisfaction.
Essential Skills
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Active Registered Nurse (RN) license in the state of Florida.
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At least 2 years of case management experience in hospital, acute care, home health, or hospice settings.
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Demonstrated experience in care management and managed care environments.
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Hands-on experience using Athena EMR software/platform for documentation and case management.
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Strong computer skills, including proficiency with Microsoft Office Suite and Excel, as well as accurate data entry and electronic documentation.
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Proven ability to manage a caseload of at least 73 members while maintaining quality and compliance.
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Experience working in fast-paced, high-acuity nursing environments.
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Strong patient care background with the ability to assess, plan, implement, and evaluate care telephonically.
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Effective triage skills to prioritize member needs and respond appropriately.
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Excellent customer service and communication skills, with the ability to build rapport and trust over the phone.
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Commitment to and genuine interest in case management work as a primary professional focus.
Additional Skills & Qualifications
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Experience in utilization management or exposure to utilization review processes.
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background in managed care settings, particularly with Medicare Advantage populations.
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Comfort working with electronic medical records and multiple digital platforms simultaneously.
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Strong organizational skills, including time management and prioritization across a large caseload.
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Attention to detail in documentation, reporting, and follow-up activities.
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Ability to work both independently and collaboratively within an interdisciplinary care team.
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Interest in wellness, preventive care, and holistic approaches to member health and well-being.
Work Environment
This position follows a hybrid work model, combining remote telephonic case management with on-site activities as needed. The standard schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m., supporting a consistent daytime work routine. You will use Athena EMR, Microsoft Office Suite (including Excel), and other digital tools to manage cases, document care, and communicate with members and providers. The environment is fast-paced and high-acuity, requiring focus, reliability, and strong computer proficiency. The role is designed for professionals who genuinely enjoy and are committed to case management work, and who thrive in a structured, technology-driven setting with clear processes and expectations. A comprehensive benefits package supports your overall well-being, including multiple medical plan options (such as HDP and PPO), prescription drug coverage, dental and vision plans, life and AD&D insurance, short-term and long-term disability coverage, a 401(k) plan with company match, wellness programs, and an Employee Assistance Program offering confidential counseling and support.
Job Type & Location
This is a Contract position based out of Orlando, FL.
Pay and Benefits
The pay range for this position is $35.00 - $40.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on May 31, 2026.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.
Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.
