Care Management Coordinator/RN - Remote – Candidate must reside in PA, NJ, or DE

Title: Care Management Coordinator/RN
Location: 100% Remote
Duration: 3+ Months (FT conversion)

Location: Remote – Candidate must reside in PA, NJ, or DE
License: Active PA RN license or Nurse Licensure Compact (NLC) that includes PA

What the client is looking for:
Minimum 3 years of Medical-Surgical clinical experience in a hospital or healthcare setting.
Strong preference for candidates with direct hospital Utilization Management/Utilization Review experience.
Experience reviewing medical records to determine medical necessity for inpatient admissions, continued stays, procedures, and ancillary services.
Experience with InterQual, MCG/Milliman, or similar medical necessity criteria is preferred.
Experience with discharge planning, precertification, medical management, or care coordination is a plus.
Strong clinical judgment, critical thinking, communication, and documentation skills.
Ability to communicate with providers and review treatment plans to determine appropriate levels of care.
Knowledge of healthcare regulations and utilization management processes.
Proficiency with Microsoft Word, Outlook, Excel, SharePoint, and Adobe.

Key Responsibilities:
Review medical records and clinical information to determine medical necessity.
Apply InterQual/medical policy criteria to inpatient and continued-stay reviews.
Communicate with providers to obtain or clarify clinical information.
Identify cases requiring Medical Director review.
Support discharge planning and appropriate care transitions.
Ensure utilization decisions comply with applicable regulatory and accreditation requirements.
Maintain accurate documentation and meet required turnaround times and productivity goals.

Education: Active PA Licensed RN required; BSN preferred.

Benefits:
We offer a competitive compensation package that includes:
•    [Pay Rate]: $42 - $45 per [Hour] 
o    Note: Pay rate will be commensurate with experience.
•    Medical for full time employees
•    Dental, and Vision Insurance
•    Life Insurance, Short-Term Disability, Long-Term Disability, etc.