Registered Nurse Care Manager – Utilization Management

Trinity Health Mid-Atlantic; Darby (Delaware County); On-site; USD 65,000 - 85,000; Part time

Benefits offered by this job

Free onsite parking

Education assistance

Referral Rewards Program

Job summary

Mercy Fitzgerald is seeking an RN Care Manager – Utilization Management to join our Care Coordination team. The role supports efficient patient care by ensuring appropriate utilization of resources and reimbursement while managing a caseload and confirming medical necessity for admission and continued stay.

The position is part-time with weekend shifts at Mercy Fitzgerald, under the supervision of the Manager of Care Coordination.

Qualifications

• BSN required.
• Active Pennsylvania RN license.
• Case management certification preferred.
• Minimum 3 years clinical experience in medical/surgical nursing.
• Experience in Case Management, Discharge Planning, Utilization Management.
• Knowledge of managed care and third-party reimbursement.
• Familiarity with InterQual criteria and MIDAS system.
• Proficient in Microsoft Office applications.
• Strong interpersonal, oral, and written communication skills.
• Ability to document effectively in electronic health records.

Responsibilities

• Perform utilization reviews to support efficient patient care.
• Apply InterQual criteria to confirm medical necessity for admission and stay.
• Collaborate with physicians and staff to ensure appropriate resource use.
• Screen patients for Intensive Case Management and discharge planning.
• Monitor patient progress and outcomes for cost-effective care.
• Document findings in the electronic health record and clinical databases.

Skills

InterQual criteria

MIDAS system

Managed care

Microsoft Office

Communication skills

Education

BSN

Job description

Position Purpose

Mercy Fitzgerald is seeking a dedicatedRN Care Manager – Utilization Management to join our Care Coordination team. Under the general supervision of the Manager of Care Coordination, this role supports the delivery of effective and efficient patient care by ensuring appropriate utilization of resources and reimbursement. The RN Care Manager is accountable for utilization management within an assigned caseload and collaborates with the healthcare team to confirm medical necessity for admission and continued stay.

What You Will Do

• Perform clinically based utilization reviews to support efficient patient care delivery.
• Apply InterQual criteria to confirm medical necessity for inpatient admission and continued stay.
• Collaborate with physicians, nurses, and other healthcare professionals to ensure appropriate resource use and reimbursement.
• Screen patients for Intensive Case Management programs, including disease management and discharge planning.
• Monitor patient progress and outcomes to support high-quality, cost-effective care.
• Document findings and interventions in the electronic health record and clinical databases.

Minimum Qualifications

• Education:
  • Bachelors of Science in Nursing (BSN) required.
• Licensure/Certification:
  • Active Registered Nurse license in the State of Pennsylvania required.
  • Case Management certification from an accredited organization preferred.
• Experience:
  • Minimum of 3 years of clinical experience, with emphasis on medical/surgical nursing.
  • Experience in Case Management, Discharge Planning, and Utilization Management preferred.
• Skills:
  • Knowledge of managed care, government payers, and third-party reimbursement.
  • Familiarity with InterQual criteria and MIDAS system preferred.
  • Proficiency in Microsoft Office applications.
  • Strong interpersonal, oral, and written communication skills.
  • Ability to document effectively in electronic health records.

Position Highlights

• Be part of a mission-driven organization focused on quality and compassionate care.
• Collaborate with a multidisciplinary team to improve patient outcomes and resource efficiency.
• Opportunity for professional growth and certification in case management.
• Competitive compensation and comprehensive benefits package.
• Comprehensive benefit packages, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from the first day of employment.
• Work/Life balance with flexible schedules.
• Free onsite parking.
• Our mission and core values are what drives each member of Trinity Health to support each other, communicate openly and respectfully while embracing a culture that nurtures a healing, safe environment for all.
• Referral Rewards Program

Benefits

• Comprehensive benefit packages, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from the first day of employment.

• Work/Life balance with flexible schedules.

• Free onsite parking.

• Our mission and core values are what drives each member of Trinity Health to support each other, communicate openly and respectfully while embracing a culture that nurtures a healing, safe environment for all.

• Referral Rewards Program

Ministry/Facility Information:

Trinity Health Mid-Atlantic was formed in October 2018 and is the largest Catholic healthcare system serving the Greater Philadelphia area and is a part of Trinity Health of Livonia, Michigan, and sponsored by Catholic Health Ministries. The hospitals and associated clinics, medical offices, specialized facilities, affiliated institutions and foundation represent more than 6,000 colleagues. These hospitals serve together in the spirit of the Gospel as a compassionate and transforming healing presence within their communities.

Employment Type: Part time Shift: Weekend Shift Description:

RN Care Manager – Utilization Management

Location: Mercy Fitzgerald
Department: Care Coordination
Schedule:Per Diem/Weekends

Position Purpose

Mercy Fitzgerald is seeking a dedicatedRN Care Manager – Utilization Management to join our Care Coordination team. Under the general supervision of the Manager of Care Coordination, this role supports the delivery of effective and efficient patient care by ensuring appropriate utilization of resources and reimbursement. The RN Care Manager is accountable for utilization management within an assigned caseload and collaborates with the healthcare team to confirm medical necessity for admission and continued stay.

What You Will Do

• Perform clinically based utilization reviews to support efficient patient care delivery.
• Apply InterQual criteria to confirm medical necessity for inpatient admission and continued stay.
• Collaborate with physicians, nurses, and other healthcare professionals to ensure appropriate resource use and reimbursement.
• Screen patients for Intensive Case Management programs, including disease management and discharge planning.
• Monitor patient progress and outcomes to support high-quality, cost-effective care.
• Document findings and interventions in the electronic health record and clinical databases.

Minimum Qualifications

• Education:
  • Bachelors of Science in Nursing (BSN) required.
• Licensure/Certification:
  • Active Registered Nurse license in the State of Pennsylvania required.
  • Case Management certification from an accredited organization preferred.
• Experience:
  • Minimum of 3 years of clinical experience, with emphasis on medical/surgical nursing.
  • Experience in Case Management, Discharge Planning, and Utilization Management preferred.
• Skills:
  • Knowledge of managed care, government payers, and third-party reimbursement.
  • Familiarity with InterQual criteria and MIDAS system preferred.
  • Proficiency in Microsoft Office applications.
  • Strong interpersonal, oral, and written communication skills.
  • Ability to document effectively in electronic health records.

Position Highlights

• Be part of a mission-driven organization focused on quality and compassionate care.
• Collaborate with a multidisciplinary team to improve patient outcomes and resource efficiency.
• Opportunity for professional growth and certification in case management.
• Competitive compensation and comprehensive benefits package.

Benefits

• Comprehensive benefit packages, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from the first day of employment.

• Work/Life balance with flexible schedules.

• Free onsite parking.

• Our mission and core values are what drives each member of Trinity Health to support each other, communicate openly and respectfully while embracing a culture that nurtures a healing, safe environment for all.

• Referral Rewards Program

Mercy Fitzgerald Hospital

is a 178-bed teaching hospital located in Darby, Pa., which offers advanced acute care services in Delaware County and Southwest Philadelphia. Consistently recognized for clinical excellence, Mercy Fitzgerald is proud of our many quality achievements such as: Blue Distinction Center for Cardiac Care, Bariatric Surgery Center of Excellence, Achievement Awards from the American Heart/Stroke Associations and Certified Primary Stroke Center.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.