Pennsylvania Licensed UM Care Manager

Job Summary

To support the UM Clinical Operations team, a flex full-time Pennsylvania Licensed UM Care Manager will manage utilization reviews, assess member barriers to care, and facilitate safe discharges from inpatient settings while working remotely with a minimum of 28 hours per week and the potential for up to 40 hours.

Key responsibilities:

• Obtain documentation to support requested levels of care and provide notifications to providers, consulting with the medical director as needed
• Document activities in the care management tracking system and identify trends for improvement based on interactions with members and providers
• Participate in interdisciplinary team conferences to discuss complex cases and determine appropriate discharge plans or levels of service

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
• PA RN license strongly preferred
• Work experience in discharge planning preferred
• BSN preferred