Pennsylvania Licensed Case Manager

Job Summary

To ensure appropriate use of hospital resources, the full-time Pennsylvania Licensed Case Manager will conduct clinical reviews, evaluate admission appropriateness, and educate on patient class assignments in a remote setting.

Key responsibilities

• Conduct timely and accurate clinical reviews to assist in patient class decision-making
• Develop and implement policies and procedures to enhance departmental efficiency
• Collaborate with care managers and other departments to facilitate appropriate patient class assignments and maximize reimbursement

Required qualifications

• Specialized Diploma in nursing
• 2 years of previous utilization review experience
• Knowledge of utilization management as it relates to third-party payers
• RN - Licensed Registered Nurse in Pennsylvania upon hire
• Ability to maintain strict adherence to HIPAA and confidentiality of PHI