RN Care Management Coordinator (Remote in Tri-State) #35740
Clinical Research
Philadelphia, PA Contract To Hire Jan 23, 2024
Contemporary Staffing Solutions is seeking an RN Care Management Coordinator to join our client for a remote opportunity (must be located in the tri-state area)! As an RN Care Management Coordinator, you will play a crucial role in overseeing and coordinating medical care for members, ensuring the provision of appropriate and cost-effective healthcare. This remote position requires an active PA license and seeks candidates with a background in UM (Utilization Management) or experience in med/surg, ER, Rehab, or Critical Care. The ideal candidate will serve as a patient advocate and resource, navigating members through the healthcare system while maintaining quality care standards. This Contract-to-Hire opportunity is offering $40/HR!

Responsibilities:
  • Assess proposed plans of treatment in alignment with precertification requirements.
  • Utilize medical criteria such as InterQual and/or Medical Policy to determine the need for inpatient care, continued stay, procedures, and ancillary services.
  • Direct the delivery of care to the most appropriate setting, ensuring quality is maintained.
  • Communicate with attending physicians to clarify medical necessity for inpatient stay or continued care.
  • Perform early identification of members for discharge planning evaluation.
  • Collaborate with facility case management, physicians, and families to determine alternative settings for discharge.
  • Identify cases not meeting established criteria and refer to Medical Directors for evaluation.
  • Report quality of care issues, delays in care, and potential utilization trends to designated management.
  • Ensure timely and accurate data entry to maintain system integrity.
  • Make utilization decisions in compliance with state, federal, and accreditation regulations.
  • Document all key functions according to Care Management and Coordination Policy.
  • Build relationships with all providers, offering exceptional customer service.
  • Educate providers on managed care principles and collaborate on improving healthcare outcomes.
  • Foster team spirit and interdepartmental rapport through effective problem-solving and motivational strategies.
  • Demonstrate flexibility, adaptability, and openness to new ideas and methods.
  • Identify opportunities for improvement in utilization processes and recommend enhancements.
  • Participate in the education of providers regarding managed care principles.
  • Perform any additional job-related duties as assigned.

Qualifications:
  • Registered Nurse (RN) with an active Pennsylvania license.
  • Background in Utilization Management (preferred) or experience in med/surg, ER, Rehab, or Critical Care.
  • Strong understanding of medical criteria such as InterQual and/or Medical Policy.
  • Excellent communication and interpersonal skills.
  • Knowledge of state, federal, and accreditation regulations related to healthcare.

Contemporary Staffing Solutions (CSS) has been a leading provider of contract, temporary, temporary-hire & direct hire solutions. We began as a staffing agency and evolved to a national provider of workforce management solutions with a niche recruitment focus in Accounting & Finance, Call Center & Office, Human Resources, Sales & Marketing, & Information Technology. To learn more about CSS, visit our website: www.ContemporaryStaffing.com.