Remote Care Management Coordinator (RN) – 3+ Month Contract

Pyramid Consulting, Inc; Philadelphia (Philadelphia County); Remote; USD 58,000 - 62,000; Full time

Benefits offered by this job

Health insurance

401(k) plan

Paid sick leave

Job summary

Pyramid Consulting, Inc. is seeking a skilled Care Management Coordinator in Philadelphia, PA (Remote) for a 3+ month contract. The role requires RN licensure in PA, UM experience, and proficiency with InterQual criteria and care coordination processes.

You will collaborate with providers, review treatment plans, ensure regulatory compliance, and document outcomes. Strong communication, organizational, and tech skills (Word, Outlook, Excel, SharePoint, Adobe) are essential; healthcare benefits

Qualifications

• Active PA Licensed RN with current licensure.
• UM experience in outpatient or inpatient settings.
• Experience with InterQual or Milliman/Roberts criteria.
• Experience in chemotherapy, infusion centers, or prior auth.
• Strong communication and problem-solving skills.

Responsibilities

• Applies critical thinking and judgement based on medical resources to determine plan appropriateness.
• Uses InterQual criteria to establish the need for inpatient stays and services.
• Contacts providers to clarify treatment plans and medical necessity.
• Reviews plans of care with providers for requested services and admissions.
• Escalates cases where plans do not meet criteria to Medical Director.
• Identifies discharge planning needs early and coordinates alternatives.
• Documents utilization decisions and ensures compliance with regulations.

Skills

Active PA Licensed RN

UM experience (Outpatient/Inpatient)

InterQual/Milliman/Robert's experience

Chemotherapy/Infusion center exposure

Excellent communication and problem‑sl

Education

BSN preferred

Tools

Microsoft Word

Outlook

Excel

SharePoint

Adobe

Job description

Pyramid Consulting, Inc. is seeking a skilled Care Management Coordinator in Philadelphia, PA (Remote) for a 3+ month contract. The role requires RN licensure in PA, UM experience, and proficiency with InterQual criteria and care coordination processes.

You will collaborate with providers, review treatment plans, ensure regulatory compliance, and document outcomes. Strong communication, organizational, and tech skills (Word, Outlook, Excel, SharePoint, Adobe) are essential; healthcare benefits