Remote Care Management Coordinator – RN, Utilization & Discharge

Pyramid Consulting, Inc; Philadelphia (Philadelphia County); On-site; 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 actively seeking a Care Management Coordinator for a 03+ months contract in Philadelphia, PA (Remote). The role focuses on clinical judgment, utilization management, and discharge planning within a health insurance setting.

The ideal candidate holds an active PA RN license, 3+ years of medical‑surgical experience, and proficiency with InterQual and related policies. Strong communication and teamwork are essential to succeed in this position.

Qualifications

• Valid PA RN license required.
• Minimum of three (3) years of Medical-Surgical clinical experience.
• Prior discharge planning and/or utilization management experience preferred.
• Exceptional communication, problem solving, and interpersonal skills.
• Ability to learn new systems and adapt to changing processes.

Responsibilities

• Applies advanced medical knowledge and guidelines to determine case suitability.
• Uses InterQual and Medical Policy to assess medical necessity of plans.
• Determines inpatient needs, continued stay, and LOS per criteria.
• Collaborates with providers to ensure appropriate care planning.
• Refers non-conforming cases to Medical Director for review.
• Supports discharge planning and alternate setting decisions.
• Documents all steps in care management policies and records.
• Identifies utilization issues and proposes improvements.

Skills

Exceptional communication

Problem solving

Interpersonal skills

Team player

Time management

Adaptability

Healthcare knowledge

Education

Active PA Licensed RN

BSN preferred

Tools

Microsoft Word

Outlook

Excel

SharePoint

Adobe products

Job description

Pyramid Consulting, Inc. is actively seeking a Care Management Coordinator for a 03+ months contract in Philadelphia, PA (Remote). The role focuses on clinical judgment, utilization management, and discharge planning within a health insurance setting.

The ideal candidate holds an active PA RN license, 3+ years of medical‑surgical experience, and proficiency with InterQual and related policies. Strong communication and teamwork are essential to succeed in this position.