Remote- Care Management Coordinator Registered Nurses

Yoh Services LLC; Philadelphia (Philadelphia County); Remote; USD 51,000 - 73,000; Full time

Benefits offered by this job

Medical, Prescription, Dental & Vision

Health Savings Account (HSA)

401K Retirement Savings Plan

Direct Deposit & weekly epayroll

Certification and training

Job summary

Yoh Services LLC is seeking a Remote-Care Management Coordinator RN for a 3-month contract. The role is remote from Philadelphia or surrounding PA area, with duties spanning medical record review, provider liaison, and care plan evaluation.

Responsibilities include ensuring medical necessity, coordinating treatment plans, and upholding regulatory compliance while supporting discharge planning and care management optimization.

Qualifications

• Minimum of three (3) years of acute care clinical experience in a hospital or other health care setting.
• RN/BSN preferred.
• Experience in outpatient settings, chemotherapy, infusion centers, or prior authorization is a plus.

Responsibilities

• Evaluate a member’s clinical condition through review of medical records.
• Directly interacts with providers to obtain additional clinical information.
• Utilize InterQual, Care Management Policy, Medical Policy, and Electronic Desk References to determine medical appropriateness of the plan.
• Contact servicing providers regarding treatment plans/plan of care and clarify medical need for services.
• Review treatment plans with providers for requested services/procedures and clarify information as needed.
• Identify cases where plans do not meet criteria and refer to Medical Director for evaluation.
• Identify discharge planning needs early and coordinate with case management.
• Report utilization issues or trends and provide improvement recommendations.
• Refer cases to Quality Management/Care Management when indicated to include delays in care.
• Ensure requests are covered within member’s benefit plan and comply with regulations.

Skills

RN

Outpatient experience

Chemotherapy

Office experience

Infusion center

Prior authorization

Education

Registered Nurse/BSN preferred

Job description

Remote-Care Management Coordinator RN

Remote-Care Management Coordinator RN needed for a contract (3 months) opportunity with Yoh’s client located in Philadelphia or surrounding PA area. This is a work from home position.

Top Skills Should You Possess:

• RN
• Candidates would have outpatient experience, chemotherapy, office, or infusion center. Best would be prior authorization experience

What You’ll Be Doing:

• Evaluate a member’s clinical condition through the review of medical records
• Directly interacts with providers to obtain additional clinical information

• Utilizes resources such as InterQual, Care Management Policy, Medical Policy, and Electronic Desk References to determine the medical appropriateness of the proposed plan.
• Contacts servicing providers regarding treatment plans/plan of care and clarifies medical need for services.
• Reviews treatment plans/plan of care with provider for requested services/procedures, inpatient admissions or continued stay, clarifying medical information with provider if needed.
• Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Director for further evaluation determination.
• Performs early identification of members to evaluate discharge planning needs.
• Collaborates with case management staff or physicians to determine alternative settings at times and provide support to facilitate discharge to the most appropriate setting.
• Reports on potential utilization issues or trends to designated manager and recommendations for improvement
• Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Manager when indicated to include delays in care.
• Appropriately refers cases to Case and Disease Management.
• Ensures request is covered within the member’s benefit plan.
• Ensures utilization decisions are compliant with state, federal and accreditation regulations.
• Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests.
• Ensures that all key functions are documented via Care Management and Coordination Policy.
• Maintains the integrity of the system information by timely, accurate data entry.
• Performs additional duties assigned.

What You Need to Bring to the Table:

• Registered Nurse/BSN preferred
• Minimum of three (3) years of acute care clinical experience in a hospital or other health care setting.
• Candidates would have outpatient experience, chemotherapy, office, or infusion center. Best would be prior authorization experience

What’s In It for You?

• Weekends and holidays off
• Join Yoh’s extensive talent community that will provide you with access to Yoh’s vast network of opportunities.
• Direct deposit & weekly epayroll

Estimated Min Rate: $45.00

Estimated Max Rate: $45.00

What’s In It for You?

• Medical, Prescription, Dental & Vision Benefits (for employees working 20+ hours per week)
• Health Savings Account (HSA) (for employees working 20+ hours per week)
• Life & Disability Insurance (for employees working 20+ hours per week)
• MetLife Voluntary Benefits
• Employee Assistance Program (EAP)
• 401K Retirement Savings Plan
• Direct Deposit & weekly epayroll
• Referral Bonus Programs
• Certification and training opportunities

Note: Any pay ranges displayed are estimations. Actual pay is determined by an applicant's experience, technical expertise, and other qualifications as listed in the job description. All qualified applicants are welcome to apply.

Yoh, a Day & Zimmermann company, is 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, or status as a protected veteran.

Visit https://www.yoh.com/applicants-with-disabilities to contact us if you are an individual with a disability and require accommodation in the application process.

For California applicants, qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All of the material job duties described in this posting are job duties for which a criminal history may have a direct, adverse, and negative relationship potentially resulting in the withdrawal of a conditional offer of employment.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

By applying and submitting your resume, you authorize Yoh to review and reformat your resume to meet Yoh’s hiring clients’ preferences. To learn more about Yoh’s privacy practices, please see our Candidate Privacy Notice: https://www.yoh.com/privacy-notice

Stay Safe During Your Job Search

Fraudulent recruiting communications have become increasingly common. Emails from Yoh recruiters will only come from an @yoh.com email address. Yoh will never ask candidates to pay fees, purchase equipment, send gift cards, or transfer funds as part of the recruiting or hiring process. If you receive a communication that appears suspicious or requests payment, contact Yoh directly before responding or sharing personal information.