Infusion Utilization Management RN | Care Coordination

IntePros; Philadelphia (Philadelphia County); On-site; USD 75,000 - 105,000; Full time

Job summary

IntePros in Philadelphia is seeking an experienced Care Management Coordinator to join our Infusion Therapy team. The role performs utilization management reviews to determine the medical necessity of requested services, ensuring evidence-based care while maintaining regulatory and accreditation compliance.

The ideal candidate is a PA-licensed RN who thrives in a collaborative environment, applies critical thinking to improve patient outcomes, and documents decisions clearly to support timely

Qualifications

• Active Pennsylvania RN license required.
• Experience in Utilization Management, Care Management, Case Management, or Prior Authorization.
• Strong knowledge of medical necessity reviews and healthcare regulations.
• Experience with InterQual or similar guidelines preferred.
• Excellent critical thinking, clinical assessment, communication, and documentation skills.
• Ability to prioritize high-volume workload with regulatory turnaround times.

Responsibilities

• Conduct medical necessity reviews for infusion therapy services using InterQual and policies.
• Review medical records and treatment plans to authorize medically necessary services.
• Collaborate with physicians to obtain additional clinical information.
• Present cases not meeting criteria to Medical Director for final determination.
• Identify discharge planning needs and support transitions of care.
• Ensure authorization decisions comply with federal, state, and accreditation requirements.
• Identify utilization trends and opportunities for process improvement.
• Document all clinical reviews accurately in care management systems.
• Serve as a clinical resource and advocate for members navigating the healthcare system.

Skills

Clinical nursing expertise

Utilization Management experience

Communication skills

Documentation skills

Critical thinking

Education

Registered Nurse license (PA)

Job description

IntePros in Philadelphia is seeking an experienced Care Management Coordinator to join our Infusion Therapy team. The role performs utilization management reviews to determine the medical necessity of requested services, ensuring evidence-based care while maintaining regulatory and accreditation compliance.

The ideal candidate is a PA-licensed RN who thrives in a collaborative environment, applies critical thinking to improve patient outcomes, and documents decisions clearly to support timely