RN Care Manager: Utilization & Discharge Planning

Trinity Health Mid-Atlantic; Darby (Delaware County); On-site; USD 65,000 - 85,000; Part time

Benefits offered by this job

Free onsite parking

Education assistance

Referral Rewards Program

Job summary

Mercy Fitzgerald is seeking an RN Care Manager – Utilization Management to join our Care Coordination team. The role supports efficient patient care by ensuring appropriate utilization of resources and reimbursement while managing a caseload and confirming medical necessity for admission and continued stay.

The position is part-time with weekend shifts at Mercy Fitzgerald, under the supervision of the Manager of Care Coordination.

Qualifications

• BSN required.
• Active Pennsylvania RN license.
• Case management certification preferred.
• Minimum 3 years clinical experience in medical/surgical nursing.
• Experience in Case Management, Discharge Planning, Utilization Management.
• Knowledge of managed care and third-party reimbursement.
• Familiarity with InterQual criteria and MIDAS system.
• Proficient in Microsoft Office applications.
• Strong interpersonal, oral, and written communication skills.
• Ability to document effectively in electronic health records.

Responsibilities

• Perform utilization reviews to support efficient patient care.
• Apply InterQual criteria to confirm medical necessity for admission and stay.
• Collaborate with physicians and staff to ensure appropriate resource use.
• Screen patients for Intensive Case Management and discharge planning.
• Monitor patient progress and outcomes for cost-effective care.
• Document findings in the electronic health record and clinical databases.

Skills

InterQual criteria

MIDAS system

Managed care

Microsoft Office

Communication skills

Education

BSN

Job description

Mercy Fitzgerald is seeking an RN Care Manager – Utilization Management to join our Care Coordination team. The role supports efficient patient care by ensuring appropriate utilization of resources and reimbursement while managing a caseload and confirming medical necessity for admission and continued stay.

The position is part-time with weekend shifts at Mercy Fitzgerald, under the supervision of the Manager of Care Coordination.