Remote RN Care Management Coordinator

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

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.