Note: The job is a remote job and is open to candidates in USA. Arlo is a company focused on rebuilding health insurance for small businesses by ensuring that premium dollars go towards care rather than the surrounding system. They are seeking a Senior Case Manager to oversee the medical journeys of members, reviewing claims and coordinating care to ensure timely and appropriate support.
Responsibilities
- Review claims, prior auth requests, and ADT (admission/discharge/transfer) data to identify members who would benefit from case management
- Conduct clinical assessments and build individualized care plans with members
- Coordinate directly with PCPs, specialists, hospitals, and post-acute providers to ensure care plans are executed and gaps are closed
- Support members through complex episodes — new diagnoses, hospitalizations, transitions of care, and chronic condition management
- Partner with our utilization management workflows on medical necessity questions and appropriate level of care
- Help us build the playbook: contribute to protocols, escalation pathways, and the tooling we use to do this work well
- Document thoroughly and maintain compliance with applicable regulatory and accreditation standards
Skills
- Active, unrestricted RN license
- 5+ years of clinical nursing experience, with relevant experience in case management, utilization management, care coordination, or discharge planning
- Comfort reading and interpreting claims data, prior auth criteria (MCG/InterQual), and clinical documentation
- Strong communication skills — you can hold your own with a skeptical specialist and also meet a member where they are
- Self-directed; you can run your panel without someone over your shoulder
- Comfort working in a fast-moving environment where processes are still being built
- Multi-state compact license strongly preferred
Company Overview
Arlo offers small and medium sized businesses affordable health benefits. It was founded in 2022, and is headquartered in New York, New York, USA, with a workforce of 11-50 employees. Its website is https://www.joinarlo.com.
