IT Recruiting/Recruiter/IT Sales Jobs | IntePros Consulting
RN Care Managmnt Coordinator
6/29/2020
Mid-Atlantic
Philadelphia, PA

IntePros is seeking a Part-time RN Care Management Coordinator to join our premier client in Philadelphia, PA! 

** Part time opportunity - Thursdays 3.75 hrs, Fridays 7.5 hrs and Saturdays 7.5 hrs. - Saturday is a must **
Training will be provided - 4-6 week orientation full time hours

Job Summary:
Under the direction of designated Clinical Precertification Manager, performs telephonic/electronic reviews from providers and members for inpatient and outpatient services. Evaluates the planned procedure or treatment for medical appropriateness and setting as well as ensure application of benefit exclusion 

Duties and Responsibilities:

  • Performs Clinical Precertification review for inpatient admissions and outpatient services.
  • Uses medical policy/medical software criteria and CMC policy as well as department guidelines for approvals, contacts attending physicians regarding treatment plans/plan of care and clarifies medical need for requested setting to obtain service
  • Refers cases to the medical director that do not meet established criteria or medical policy guidelines 
  • Performs early identification of hospitalized members to evaluate discharge planning needs
  • Maintains the integrity of the system information by timely, accurate data entry
  • Utilization decisions are in compliance with state, federal and accreditation regulations
  • Ensures that all key functions are documented via Care Management and Coordination Policy
  • Works to build relations with all providers and provides exceptional customer service
  • Reports potential utilization issues or trends to designated manager or senior care coordinator and recommendations for improvement
  • Participates in the process of educating providers on managed care
  • Is comfortable with new ideas and methods; creates and acts on new opportunities; is flexible and adaptable
  • Builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy

Requirements:

  • Education and experience:Registered Nurse with active RN license  
  • BS preferred
  • Minimum of three years of acute care clinical experience in a hospital or other health care setting
  • Exceptional communication, problem solving, and interpersonal skills; focused, professional, action oriented with strong ability to set priorities and obtain results
  • Organized and demonstrates excellent team management skills
  • Team Player
  • Ability to effectively utilize time management
 

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