Pennsylvania Licensed Care Manager

Job Summary

To support the Utilization Management Clinical Operations Department, a full-time Pennsylvania Licensed Care Manager will perform utilization reviews of health plan services, assess member barriers to care, and collaborate with healthcare providers while working remotely during standard daylight hours, Monday through Friday.

Key responsibilities

• Obtain and document necessary information for level of care requests and consult with medical directors on medical necessity
• Conduct clinical reviews for authorization requests using established criteria and document all activities in the care management tracking system
• Participate in interdisciplinary team conferences to discuss complex cases and develop appropriate discharge plans

Required qualifications

• Minimum of 2 years of experience in clinical and/or case management nursing
• Minimum of 1 year of work-related experience in Utilization Management
• Experience with prior authorizations preferred
• Current Pennsylvania RN license preferred
• Case management certification or approved clinical certification preferred