RN Care Management Coordinator

IntePros; Philadelphia (Philadelphia County); On-site; USD 55,104 - 61,992; Full time

Job summary

A healthcare staffing firm is looking for a Care Management Coordinator in Philadelphia. The ideal candidate must hold an active Pennsylvania RN license and demonstrate strong clinical judgment to evaluate healthcare cases. Responsibilities include reviewing medical records, communicating with providers, and ensuring compliance with guidelines. This contract position offers a competitive pay rate of $40.00-$45.00 per hour.

Qualifications

• Active Pennsylvania RN license required.
• Ability to evaluate clinical conditions effectively.
• Experience with Care Management Policies preferred.

Responsibilities

• Evaluate clinical conditions by reviewing medical records.
• Communicate with healthcare providers for treatment clarification.
• Maintain documentation per Care Management policies.

Skills

Critical thinking

Clinical judgment

Communication

Data entry accuracy

Education

Active Pennsylvania RN license

Tools

InterQual criteria

Medical Policies

Job description

4 days ago Be among the first 25 applicants

This range is provided by IntePros. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$40.00/hr - $45.00/hr

Direct message the job poster from IntePros

Senior Healthcare Recruiter @ IntePros | Technology Staffing

Job Title: Care Management Coordinator

Department: Care Management and Coordination

Team: Infusion Therapy

License Requirement: Active Pennsylvania RN license (PA RN only)

Position Summary

The Care Management Coordinator plays a vital role in evaluating members’ clinical conditions by reviewing medical records—including histories and treatment plans—to determine the medical necessity of requested services. This evaluation relies on advanced clinical knowledge, independent analysis, and the application of medical necessity criteria. When additional information is needed, the Coordinator communicates directly with healthcare providers.

Key Responsibilities

• Apply critical thinking and clinical judgment to evaluate cases, using guidelines and available tools to determine medical necessity.
• Utilize InterQual criteria, Care Management Policies, Medical Policies, and Electronic Desk References to assess appropriateness of services including inpatient admissions, procedures, and ancillary care.
• Communicate with servicing providers to clarify treatment plans and medical needs for requested services.
• Refer cases that do not meet established criteria to the Medical Director for further evaluation and decision-making.
• Proactively identify members who may need discharge planning support and collaborate with physicians and case managers to facilitate transition to appropriate care settings.
• Monitor and report utilization trends or concerns to management with suggested improvements.
• Refer cases to Quality Management, Case Management, or Disease Management teams as appropriate.
• Confirm that service requests fall within the member’s benefit coverage.
• Ensure all utilization decisions align with state, federal, and accreditation guidelines.
• Meet or exceed regulatory turnaround times and departmental productivity benchmarks for processing referrals and authorizations.
• Maintain accurate and timely documentation in accordance with Care Management and Coordination policies.
• Preserve system data integrity through precise and prompt data entry.
• Perform additional duties as assigned.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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