Remote Nurse Health Coach (RN)

Post Acute Utilization Manager (RN)

• This is a POST ACUTE PART TIME RN position – the manager is looking for a candidate to Monday and Tuesday 8:45-5, with potential for additional days. **Must be available M-F 8:30-4:30pm for 2-3 weeks of training at start of assignment.
• Job Type: Contract
• Assignment Dates: September 21, 2026 – December 26, 2026
• Residency Requirement: Remote but candidates must reside in Pennsylvania (PA), New Jersey (NJ), or Delaware (DE)
• Pay Rate: Up to $44/hour

Job Summary

Under the direction of a designated Manager, performs telephonic review of hospital admissions, recommending alternative levels of care when appropriate. Works to add value to healthcare by encouraging efficient and high quality use of the healthcare delivery system. Promotes timely and dynamic discharge planning to facilitate early discharge and refers cases to Case Management when indicated. Efficiently collaborates with the hospital utilization review department, attending physicians and members/families as appropriate.

Key Responsibilities

Performs telephonic utilization management

• Using the medical software criteria, establish the need for inpatient, continued stay and length of stay.
• Directs the delivery of care to the most appropriate setting, while maintaining quality.
• Contacts attending physicians regarding treatment plans/plan of care and clarifies medical need for inpatient stay or continued inpatient care
• Identifies inpatient admissions no longer meeting criteria and refers care to plan Medical Directors for evaluation.
• Presents cases to Medical Directors that do not meet established criteria and provides pertinent information regarding members medical condition and the potential home care needs.
• Performs early identification of hospitalized members to evaluate discharge planning needs.
• Collaborates with hospital case management staff, physician and family to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting.
• Identifies and refers cases for case management and disease management.
• Identifies quality of care issues including delays in care. Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Supervisor when indicated.
• Maintains the integrity of the system information by timely, accurate data entry. Utilization decisions are in compliance with state, federal and accreditation regulations.
• Works to build relations with all providers and provides exceptional customer service.
• Reports potential utilization issues or trends to designated supervisor and recommendations for improvement.
• Participates in the process of educating providers on managed care.

Qualifications

• Registered Nurse/BS preferred.
• Must have Active PA RN license or compact license to include PA.
• This is a remote position; however, the candidate must reside in the tri-state area (PA, NJ, DE).
• Minimum of three (3) years of clinical experience in a hospital or other health care setting.
• Prior Post Acute discharge planning and/or utilization management experience is required

Medical, dental, and vision insurance are available to qualified candidates who meet eligibility requirements.

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