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

Independence Blue Cross; Philadelphia (Philadelphia County); Remote; USD 75,000 - 95,000; Full time

Job summary

A leading healthcare services provider is seeking a licensed registered nurse for a fully remote position. The role involves overseeing medical care, collaborating with healthcare professionals, and ensuring compliance with healthcare regulations. This position offers career advancement, flexibility, and a chance to make a positive impact on patient care.

Benefits

Career advancement opportunities

Fully remote work

Engaging work environment

Competitive pay focused on equitable health solutions

Qualifications

• Minimum of three years of clinical experience preferred in Intensive Care, Trauma, or Home Health.
• Active PA Licensed Registered Nurse required.

Responsibilities

• Oversee and coordinate medical care for members ensuring appropriate treatment.
• Evaluate treatment plans based on precertification requirements.
• Collaborate with physicians regarding discharge planning needs.

Skills

Problem-solving

Critical thinking

Microsoft Office Suite

Education

BSN preferred

Licensed registered nurse in PA

Job description

Employer Industry: Healthcare Services

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Fully remote position, allowing for flexibility in work location
- Engaging work environment that encourages innovation and new ideas
- Competitive pay with a focus on equitable health solutions
- Chance to act as a patient advocate and make a positive impact on member care

What to Expect (Job Responsibilities):
- Oversee and coordinate medical care for members to ensure appropriate and cost-effective treatment
- Evaluate treatment plans based on precertification requirements and medical criteria
- Collaborate with physicians and facility staff to determine discharge planning needs and alternative care settings
- Identify quality of care issues and ensure compliance with regulations regarding utilization decisions
- Maintain accurate data entry and document key functions per Care Management and Coordination Policy

What is Required (Qualifications):
- Licensed registered nurse in the state of PA, BSN preferred
- Minimum of three years of clinical experience or equivalent, with experience in Intensive Care, Trauma, or Home Health preferred
- Active PA Licensed Registered Nurse required
- Proficiency in Microsoft Office Suite and other relevant software programs
- Strong problem-solving and critical thinking abilities

How to Stand Out (Preferred Qualifications):
- Experience in medical management or precertification processes
- Familiarity with current trends in medical practice
- Excellent organizational planning and prioritizing skills
- Highly professional interpersonal skills for effective communication with internal and external contacts

#HealthcareServices #RemoteWork #PatientAdvocacy #CareerGrowth #InnovativeHealthcare

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