Job Description

Immediate need for a talented RN Care management Coordinator/Utilization Management RN . This is a 03+ 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: 25-91229

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:

• RN license required or Nurse Licensure Compact that includes Pennsylvania for Registered Nurses licensed in another state and maintain their license in the name under which they are currently working.
• Full-time ONLY during training - 2-3 weeks, Must be available M-F for the training period .
• Permanent schedule - This position will be 5 full days over a two week period - 2 days 1st week, and 3 days the 2nd week.
• 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; NICU, 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.
• 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.

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