RN Care Managmnt Coordinator

Job DetailsJob Title Care Management Coordinator- Clinical Precertification Location Philadelphia, PA 19103 Duration 3 Months (Possible Extension or Permanent FTE role conversion) Shift Time M- F, 08:30 AM - 5:00 PM, 37.5 hours/week with potential for OT if volume dictates Start Date 3rd week of Jun 2022 Tentatively Summary: Under the direction of a designated Care Management and Coordination -, 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. Roles & Responsibilities: Performs Clinical Precert reviews for inpatient admissions and outpatient services as well as coverage for a service or procedure. Using 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. Performs additional related duties as assigned. Knowledge, skills, and abilities required: Education and experience: Registered Nurse with active RN license in State of employment. BS preferred. Minimum of one year of acute care clinical experience in a hospital or other health care setting. Skills: Exceptional communication, problem solving, and interpersonal skills; focused, professionalism, action oriented with strong ability to set priorities and obtain results. Organized, demonstrates excellent team management skills Team Player. Ability to effectively utilize time management. Education and experience: PA Licensed Registered Nurses required BS Degree preferred Minimum of three (3) years of acute care clinical experience in a hospital or other health care setting. Prior discharge planning and/or utilization management experience is desirable. Driver''s License and access to automobile required. Additional Skills Required: Exceptional communication skills on all levels. Problem solving ability Organized, demonstrated excellent team management skills Team Player prof1 J2W:CB3 Get job alerts by email. Sign up now!

Created: 2025-11-15