Pennsylvania Licensed RN Case Manager
Job Summary
To support care management needs, the full-time contract Pennsylvania Licensed RN Case Manager will apply critical thinking and medical knowledge to evaluate cases, determine treatment plans, and collaborate with healthcare providers remotely from Philadelphia, PA.
Key responsibilities
- Utilize medical criteria to assess the appropriateness of treatment plans and inpatient care
- Collaborate with case management staff and providers to facilitate discharge planning and alternative care settings
- Identify and report potential utilization issues and trends to management for improvement
Required qualifications
- Active Pennsylvania RN license or Nurse Licensure Compact including PA
- Prior authorization experience
- Experience with InterQual and medical policy guidelines
- Ability to perform case evaluations and discharge planning
- Knowledge of care management processes and healthcare regulations
Complete Job Description
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