Pennsylvania Licensed Care Management RN

Job Summary

To support effective patient care, the full-time contract Pennsylvania Licensed Care Management RN will apply advanced medical knowledge to assess cases, utilize clinical guidelines for treatment plans, and collaborate with healthcare providers to ensure compliance and appropriateness of care, all while working remotely from Philadelphia, PA.

Key responsibilities:

• Apply critical thinking to evaluate cases and determine medical appropriateness using established guidelines
• Collaborate with providers to review treatment plans and clarify medical needs for services
• Identify cases requiring further evaluation and ensure compliance with regulatory standards

Required qualifications:

• Active Pennsylvania RN license
• Minimum of three years of Medical Surgical clinical experience in a healthcare setting
• Experience with InterQual and/or Medical Policy
• Prior discharge planning or utilization management experience preferred
• BSN is a preferred qualification