Care Management Coordinator - Impactful Care & Approvals

Volt; Philadelphia (Philadelphia County); On-site; USD 55,000 - 62,000; Full time

Benefits offered by this job

health

dental

vision

term life

short term disability

AD&D

401(k)

Sick time

other types of paid leaves (as require

Employee Assistance Program (EAP)

Job summary

Volt is hiring a Care Management Coordinator in Philadelphia, PA. The role focuses on applying clinical judgment to determine medical appropriateness and discharge planning while coordinating with providers and the Medical Director as needed.

Responsibilities include using InterQual and Medical Policy to assess plans, ensuring regulatory compliance, and maintaining timely documentation. The position offers a competitive hourly pay rate and benefits. Volt is an Equal Opportunity Employer.

Qualifications

• Must hold an active PA license (or Nurse Licensure Compact to include PA).
• Prior authorization experience is required.
• Pay rate is $40.00 - $45.00 per hour.

Responsibilities

• Apply critical thinking and judgement based on medical guidelines to determine case determinations.
• Use InterQual, Medical Policy, and other references to assess medical appropriateness of proposed plans.
• Determine need for inpatient admission, continued stay, and length of stay and related services.
• Coordinate with providers on treatment plans and clarifications of medical need.
• Review plans with providers for requested services and admissions.
• Refer cases to Medical Director when criteria are not met.
• Identify discharge planning needs early and support appropriate settings.
• Collaborate with care management staff to arrange alternatives and facilitate discharge.
• Flag potential utilization issues and suggest improvements to managers.
• Route cases to Quality Management or Case Management when delays occur.
• Ensure care requests are covered by member benefit and compliant with regulations.
• Document all key functions in Care Management policies.
• Maintain accurate system data entry and perform other duties as assigned.

Skills

Active PA license

Prior authorization experience

Job description

Volt is hiring a Care Management Coordinator in Philadelphia, PA. The role focuses on applying clinical judgment to determine medical appropriateness and discharge planning while coordinating with providers and the Medical Director as needed.

Responsibilities include using InterQual and Medical Policy to assess plans, ensuring regulatory compliance, and maintaining timely documentation. The position offers a competitive hourly pay rate and benefits. Volt is an Equal Opportunity Employer.