Remote Case Manager: Utilization & Care Coordination

Lehigh Valley Health Network, Inc.; Philadelphia (Philadelphia County); Remote; USD 65,000 - 90,000; Full time

Job summary

Lehigh Valley Health Network is seeking an experienced RN for Utilization Management. You will review admissions for appropriateness, document decisions, and collaborate with care teams to optimize patient care and payer requirements.

The role emphasizes adherence to HIPAA, attention to detail, and efficient processing within a remote Pennsylvania setting. Shift: Day, department: Utilization Management.

Qualifications

• Specialized Diploma in nursing.
• 2 years of utilization review experience.
• 2 years knowledge of utilization management for third-party payers.
• Maintain HIPAA confidentiality.
• Team-oriented with flexibility to prioritize.
• Detail-oriented with timely task completion.
• Proficient with work queue processes.
• Knowledge of evidence-based clinical decision support criteria.

Responsibilities

• Reviews patient admissions for appropriateness using approved criteria.
• Provides timely and accurate clinical reviews for patient class decisions.
• Implements policies to improve departmental efficiency and effectiveness.
• Collaborates with care managers and departments to exchange information on patient needs.
• Documents authorizations and downgrades per policy.
• Participates in Performance Improvement initiatives to meet annual goals.

Skills

Utilization review

HIPAA adherence

Team collaboration

Attention to detail

Communication

Prioritization

Education

Specialized Diploma in nursing

RN - Licensed Registered Nurse (PA) Upon Hire

Job description

Lehigh Valley Health Network is seeking an experienced RN for Utilization Management. You will review admissions for appropriateness, document decisions, and collaborate with care teams to optimize patient care and payer requirements.

The role emphasizes adherence to HIPAA, attention to detail, and efficient processing within a remote Pennsylvania setting. Shift: Day, department: Utilization Management.