Care Management Coordinator RN (UM) - AHA remote (PA/NJ/DE)

Independence Blue Cross; Philadelphia (Philadelphia County); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking a Registered Nurse for a fully remote position focusing on patient advocacy and health management. This role offers an opportunity for career advancement, a collaborative work environment, and a competitive salary with comprehensive healthcare options. Ideal candidates will have a Pennsylvania RN license and clinical experience, preferably in critical care or home health, and will engage in meaningful work supporting quality care standards.

Benefits

Fully remote position

Flexible work hours

Competitive salary and benefits package

Career advancement opportunities

Qualifications

• Minimum three years of clinical experience.Required experience in Intensive Care, Trauma or Home Health preferred.
• Prior experience in medical management or precertification preferred.

Responsibilities

• Oversee and coordinate medical care provided to members.
• Collaborate with physicians and facility case management staff to facilitate appropriate care settings.
• Maintain accurate data entry and documentation in compliance with regulations.

Skills

Problem-solving

Critical thinking

Communication

Education

Active Registered Nurse license in Pennsylvania

BSN preferred

Tools

Microsoft Office Suite

Job description

Employer Industry: Healthcare Services

Why consider this job opportunity:
- Fully remote position with flexibility to work from the Tri-State Area of Delaware, New Jersey, or Pennsylvania
- Opportunity for career advancement and growth within the organization
- Collaborative work environment focused on innovation and quality care
- Engaging in meaningful work that supports patient advocacy and health management
- Competitive salary and benefits package, including comprehensive healthcare options

What to Expect (Job Responsibilities):
- Oversee and coordinate medical care provided to members, ensuring adherence to quality care standards
- Evaluate proposed treatment plans and establish the necessity for inpatient stays and procedures
- Collaborate with physicians and facility case management staff to facilitate appropriate care settings
- Identify quality of care issues and refer cases to the Quality Management Department as needed
- Maintain accurate data entry and documentation in compliance with regulations

What is Required (Qualifications):
- Active Registered Nurse license within the state of Pennsylvania; BSN preferred
- Minimum of three years of clinical experience, with experience in Intensive Care, Trauma, or Home Health preferred
- Prior experience in medical management or precertification preferred
- Strong problem-solving and critical thinking skills
- Proficiency in Microsoft Office Suite and other relevant software programs

How to Stand Out (Preferred Qualifications):
- Experience in medical management or precertification processes
- Familiarity with current trends in medical practice
- Ability to educate providers on managed care practices
- Strong interpersonal skills for effective communication with internal and external stakeholders

#HealthcareServices #RemoteWork #CareerGrowth #PatientAdvocacy #ClinicalExcellence

We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.