Job Description
Contract Opportunity - Care Management Coordinator (RN) Duration: 1+ year Location: Remote (Candidate must reside in the Tri-State NJ, PA, DE area for eligibility for potential conversion) Job Category: Insurance Professional & Clinical Pay rate: $40/HR on W2 (negotiable) Job Summary PENNSYLVANIA NURSING LICENSE is required. We are seeking a Care Management Coordinator (RN) to join our Care Management and Coordination team. In this role, you will conduct telephonic and/or onsite reviews of hospital admissions, determine appropriate care settings, and support timely discharge planning. You will collaborate with physicians, hospital staff, patients, and families to ensure high-quality, cost-effective care. Key Responsibilities • Perform utilization management for inpatient admissions (onsite and telephonic). • Apply clinical criteria to determine need for admission, continued stay, and length of stay. • Facilitate care delivery in the most appropriate setting while maintaining quality. • Communicate with attending physicians regarding treatment plans and medical necessity. • Refer cases not meeting criteria to Medical Directors for evaluation. • Identify discharge planning needs early and collaborate with hospital staff, physicians, and families. • Refer cases for case management, disease management, or quality review when appropriate. • Maintain accurate and timely data entry in compliance with regulations. • Build strong provider relationships and deliver excellent customer service. • Report utilization trends and recommend improvements. • Participate in provider education regarding managed care. • Perform other related duties as assigned. Qualifications • Active PA RN license (required). • Minimum of 3 years acute care clinical experience in a hospital or healthcare setting. • Experience in discharge planning and/or utilization management preferred. Skills • Strong communication and interpersonal skills. • Effective problem-solving and critical-thinking abilities. • Highly organized with strong attention to detail. • Collaborative team player with proven ability to work across disciplines. Benefits: We offer a competitive compensation package that includes: • Medical for full time employees • Dental, and Vision Insurance • Life Insurance, Short-Term Disability, Long-Term Disability, etc. Please apply with your interest. You may also reach out to me directly at [email protected] Thank you, Ashu Apply tot his job