RN Care Management Coordinator #36559
Clinical
Philadelphia, PA Contract To Hire Jun 14, 2024
Contemporary Staffing Solutions is seeking a RN Care Management Coordinator to join our client for a remote opportunity! The RN Care Management Coordinator ensures that staff performance complies with regulations and standards applicable to Utilization Management operations. This role involves monitoring the medical review process, ensuring appropriate medical necessity determinations, and coordinating business operations support for various compliance activities. This Contract-to-Hire opportunity offers up to $45/Hour!

Responsibilities:
  • Evaluate NCQA, CMS, and state regulations to ensure appropriate controls are in place. Recommend and oversee the implementation of new controls as necessary.
  • Identify and report potential issues and trends monthly, impacting efficiency and quality based on compliance audit findings. Present findings to Managers and Directors.
  • Conduct ongoing sample case reviews to ensure staff correctly apply InterQual and medical/departmental policy guidelines. Ensure relevant and useful information is provided to Medical Directors for decision-making.
  • Ensure clinical staff document appropriately in the medical management system so that member letters are clear, understandable, and meet regulatory requirements.
  • Serve as a resource for internal and external inquiries. Utilize excellent communication skills to respond in a timely and professional manner.
  • Perform additional tasks as assigned to support the compliance and care management functions.

Qualifications:
  • Minimum of five (5) years of clinical experience.
  • Active PA and/or NJ Licensed Registered Nurse required. LPNs with relevant experience may be considered.
  • BSN preferred.
  • Strong interpersonal skills with the ability to provide constructive feedback and maintain positive, productive relationships.
  • Knowledge of utilization review processes and management systems, with a strong understanding of InterQual.
  • Excellent verbal and written communication skills, with keen attention to detail.
  • Proficiency in Microsoft Excel, PowerPoint, and Word.
  • Experience adhering to NCQA, CMS, and other regulatory compliance programs.
  • Strong problem-solving abilities, organizational skills, and planning capabilities.