RN Care Management Coordinator

Pyramid Consulting, Inc; Philadelphia (Philadelphia County); Remote; USD 55,104 - 61,992; Part time

Benefits offered by this job

Health insurance

401(k) plan

Paid sick leave

Job summary

A prominent health insurance provider is seeking an RN Care Management Coordinator for a 3-month contract with potential for extension. This remote position in the Philadelphia area requires an active PA RN license and a minimum of three years of acute care experience. Responsibilities include utilizing medical criteria to determine case appropriateness, collaborating on discharge planning, and ensuring regulatory compliance. Competitive pay of $40-$45 per hour with benefits included. Interested candidates should apply for immediate consideration.

Qualifications

• Active PA Licensed RN or compact license that includes PA.
• Minimum of three (3) years of acute care clinical experience.
• Prior discharge planning and/or utilization management experience is desirable.

Responsibilities

• Applies critical thinking and judgment to make case determinations.
• Utilizes resources to determine medical appropriateness of proposed plans.
• Contacts servicing providers regarding treatment plans.
• Identifies and refers cases that do not meet established criteria.

Skills

Critical thinking

Judgment skills

Case determination

Compliance with regulations

Education

Active PA Licensed RN

BSN

Job description

Immediate need for a talented RN Care Management Coordinator. This is a 03 months Contract opportunity with long-term potential and is located in PA, DE, NJ (Remote). Please review the job description below and contact me ASAP if you are interested.

Job Diva ID

Job Diva ID: 25-94789

Pay Range

Base pay: $40.00/hr - $45.00/hr. Pay range: $40 - $45 /hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities

• Applies critical thinking and judgement skills based on advanced medical knowledge to cases utilizing specified resources and guidelines to make case determination.
• Utilizes resources such as InterQual, American Society of Addiction Medicine criteria (ASAM), Care Management Policy, Medical Policy and Electronic Desk References to determine the medical appropriateness of the proposed plan.
• Utilizes the behavioral health criteria of InterQual, ASAM and/or Medical Policy to establish the need for inpatient, continued stay and length of stay, procedures and ancillary services.
• Contacts servicing providers regarding treatment plans/plan of care and clarifies medical need for services.
• Reviews treatment plans/plan of care with provider for requested services/procedures, inpatient admissions or continued stay, clarifying behavioral health information with provider if needed.
• Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Director for further evaluation determination.
• Performs early identification of members to evaluate discharge planning needs.
• Collaborates with case management staff or physician to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting.
• Reports potential utilization issues or trends to designated manager and recommendations for improvement.
• Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Manager when indicated to include delays in care.
• Appropriately refers cases to Case and Disease Management.
• Ensures request is covered within the member’s benefit plan.
• Ensures utilization decisions are compliant with state, federal and accreditation regulations.
• Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests.
• Ensures that all key functions are documented in accordance with Care Management Coordination Policy.
• Maintains the integrity of the system information by timely, accurate data entry.
• Performs additional duties assigned.

Key Requirements and Technology Experience

• Active PA Licensed RN or compact license that includes PA
• BSN Preferred
• Minimum of three (3) years of acute care clinical experience in a hospital or other health care setting
• Prior discharge planning and/or utilization management experience is desirable.

Our client is a leading Health Insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Equal Employment Opportunity Statement

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.