Managing the care transition of high-risk participants, the full-time Registered Nurse - Clinical Programs will oversee discharge planning, collaborate with healthcare teams, and ensure quality care management in a remote setting. Key responsibilities Collaborate with hospitals and providers to develop and implement safe discharge plans for participants Conduct clinical reviews and authorize services based on evidence-based medical necessity criteria Document care management services and maintain compliance with regulations and standards Required qualifications Bachelor of Science in Nursing (BSN) required 3-5 years of experience in a hospital or home care clinical setting Knowledge of Medicare and Medicaid guidelines Experience in case management and discharge planning preferred 2-3 years of Utilization Review experience at a Managed Care Organization is beneficial