Job Description

Job Description

Immediate need for a talented RN Care management Coordinator/Utilization Management RN. This is a 04+months contract opportunity with long-term potential and is located in Philadelphia, PA(Remote) . Please review the job description below and contact me ASAP if you are interested.

Job ID:25-91668

Pay Range: $42 - $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:

• Performs 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 meeting 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 member?s medical condition and the potential home care needs.
• Performs early identification of hospitalized members to evaluate discharge planning needs.
• Collaborates with hospital case management staff, physician and family to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting.
• Identifies and refers cases for case management and disease management.
• Identifies quality of care issues including delays in care.
• Appropriately refers 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 supervisor and recommendations for improvement.
• Participates in the process of educating providers on managed care.
• Performs additional related duties as assigned.

Key Requirements and Technology Experience:

• Key Skills; Prior Authorization, Utilization management, Discharge Planning.
• Registered Nurse .
• BS 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 required.
• Medical management/precertification experience preferred.
• Exceptional communication skills on all levels
• Proficiency in using computerized applications
• Problem solving ability
• Organized, demonstrated excellent team management skills
• Team Player

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.

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.

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.

Job Tags

Similar Jobs