Utilization Management RN - Healthcare & Research - Analysts

MassGenics, Inc.; Philadelphia (Philadelphia County); Hybrid; USD 55,000 - 62,000; Part time

Benefits offered by this job

Medical & pharmacy coverage

Dental/vision insurance

401(k)

Health saving account (HSA) and FSA

Life Insurance

Disability insurance

EAP

Job summary

Innova Solutions is hiring a Utilization Management RN for a part-time contract-to-hire role in Philadelphia, PA. The RN will perform telephonic utilization management for inpatient admissions and verify need for inpatient care using criteria.

The role focuses on directing care to the appropriate setting and coordinating with physicians and Medical Directors. Ideal candidates hold an active PA RN license, have 3+ years in acute care, and possess discharge planning or UM experience.

Qualifications

• Active PA RN license or compact PA license.
• 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.

Responsibilities

• Perform telephonic utilization management for inpatient admissions.
• Using medical software criteria, establish need for inpatient, continued stay and length of stay.
• Direct care delivery to the most appropriate setting while maintaining quality.

Skills

PA RN license

acute care experience

discharge planning

utilization management

Education

BSN

Job description

Innova Solutions has a client that is immediately hiring for a Utilization Management RN
Position type: Part Time – Contract to hire
Duration: 03 Months
Location: Philadelphia, PA

As a Utilization Management RN, you will:

• Perform telephonic utilization management for inpatient admissions.
• Using the medical software criteria, establish the need for inpatient, continued stay and length of stay.
• Directs the delivery of care to the most appropriate setting, while maintaining quality.
• Contacts attending physicians regarding treatment plans/plan of care and clarifies medical need for inpatient stay or continued inpatient care
• Identifies inpatient admissions no longer meet criteria and refers care to plan Medical Directors for evaluation.
• Presents cases to Medical Directors that do not meet established criteria and provides pertinent information regarding members’ medical condition and the potential home care needs.
• Performs early identification of hospitalized members to evaluate discharge planning needs.
• Collaborate with hospital case management staff, physicians and family to determine alternative settings at times and provide support to facilitate discharge to the most appropriate setting.
• Identifies and refers for case management and disease management.
• Identifies quality of care issues including delays in care. Appropriately refers to cases to the Quality Management Department and/or Care Management and Coordination Supervisor when indicated.
• Maintains the integrity of the system information by timely, accurate data entry. Utilization decisions are in compliance with state, federal and accreditation regulations.
• Works to build relations with all providers and provides exceptional customer service.
• Reports potential utilization issues or trends to designated supervisors and recommendations for improvement.
• Participates in the process of educating providers on managed care.

The Ideal Candidate will have:

• Active PA RN license or compact license to include PA.
• 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.

Preferred Qualification:

• BSN

This position is only open to applicants who can be engaged on a W-2 basis.

We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines.

Thank you! Thank you!

Gandam Meghana
218-325-3819
[e-mail]

PAY RANGE AND BENEFITS:

Pay Range*: $40 - $45 per hour

*Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.

Benefits:

• Medical & pharmacy coverage
• Dental/vision insurance
• 401(k)
• Health saving account (HSA) and Flexible spending account (FSA)
• Life Insurance
• Pet Insurance
• Short term and Long term Disability
• Accident & Critical illness coverage
• Pre-paid legal & ID theft protection
• Sick time
• and other types of paid leaves (as required by law)
• Employee Assistance Program (EAP)

ABOUT INNOVA SOLUTIONS:

Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.

Recent Recognitions:

Named One of America’s Best Employers for New Grads by Forbes (2024

Named One of the Best Companies to Work For by U.S. News & World Report (Private Companies List, 2024-2025)

One of the Largest IT Staffing Firms in the US – Ranked #3 by Staffing Industry Analysts (SIA, 2024)

One of the Largest Staffing Firms in the US – Ranked #13 by Staffing Industry Analysts (SIA, 2024; includes Innova Solutions, Volt, & HireGenics)

Named One of the Top Ten Private Companies in Atlanta by the Atlanta Business Chronicle (2023)

One of the Largest Certified Minority Business Enterprises (MBEs) in the United States (NMSDC, 2024)

AWS Advanced Tier Services Partner with 100+ certifications

Website: https://www.innovasolutions.com/

Innova Solutions offers a referral bonus for qualified Ambassadors who refer eligible referrals. Submit referrals at https://innovasolutions.workllama.com/atsuser/anonreferafriend and earn $250-$1,000 per referral

Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at [e-mail] or [phone]. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b.
The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.

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