RN Case Management

Job Summary

We are seeking an experienced RN Case Management professional for a direct hire opportunity in Miami, FL within the insurance industry. This role is ideal for a Florida-licensed Registered Nurse who enjoys clinical review, utilization management, patient and provider communication, and careful interpretation of medical guidelines and policy terms.

Responsibilities

- Conduct pre-certification reviews for services such as MRI requests, physical therapy extensions, and other medically reviewed cases.
- Review clinical information and approve or deny cases based on MCG guidelines and applicable policy terms.
- Communicate directly with providers and patients to gather information, explain review outcomes, and support case resolution.
- Handle pre-existing condition claim reviews with accuracy, consistency, and appropriate documentation.

Compensation and Benefits

- Direct hire opportunity.
- Salary: $95,000 per year.
- Location: Miami, FL.
- Work arrangement: In-office only

Equal Opportunity Employer / Disabled / Protected Veterans

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For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

Additional Skills

- Must be a Registered Nurse with an active Florida RN license.
- 3 to 5 years of relevant clinical, case management, utilization review, or insurance-related experience preferred.
- Strong English communication skills required for direct provider and patient interaction.
- Ability to apply clinical judgment while following established guidelines, policy language, and compliance standards.