Pennsylvania Licensed UM Care Manager (RN)

Job Summary

To support the UM Clinical Operations team, a part-time Pennsylvania Licensed UM Care Manager (RN) will manage utilization reviews and assessments of member barriers to care, ensuring safe and coordinated discharges while working remotely during scheduled hours from 8:00 AM to 4:30 PM EST, Monday through Friday.

Key responsibilities:

• Review and document clinical information from healthcare providers and conduct clinical reviews for authorization requests using established criteria
• Coordinate with health plan case managers to determine discharge needs and facilitate transitions in care
• Participate in interdisciplinary team conferences to discuss complex cases and document all activities in the care management tracking system

Required qualifications:

• Minimum of 2 years of experience in clinical and/or case management nursing
• BSN or MSN strongly preferred
• Prior UM and psych experience strongly preferred
• Current Pennsylvania RN license strongly preferred
• Work experience in discharge planning preferred