Remote Part Time Registered Nurse – Pennsylvania

Care Management Coordinator (Home Health Team)

Remote | Part-Time (18.75 Hours/Week) | PA RN License Required

We’re hiring a Care Management Coordinator to support our Home Health Team in a remote, part-time role with potential for permanent conversion.

What You’ll Do

• Review medical records and clinical documentation to determine medical necessity for services
• Apply InterQual criteria, medical policies, and clinical guidelines to authorization decisions
• Collaborate with providers to obtain additional clinical information and clarify treatment plans Approve medically necessary services and escalate non-qualifying cases to the Medical Director for review
• Support discharge planning and care coordination activities
• Ensure compliance with state, federal, and accreditation requirements
• Serve as a patient advocate and resource for members navigating the healthcare system

Required Qualifications

• Active Pennsylvania RN License
• Strong clinical review and assessment experience
• Experience in utilization management, care management, case management, or home health
• Excellent communication and critical thinking skills
• Ability to work independently in a remote environment

Preferred Qualifications

• Home Health experience
• Managed Care or Health Plan experience
• InterQual experience

Schedule

• 18.75 hours per week
• Two 7.5-hour shifts + one 3.75-hour shift
• One shift must fall on Friday (full or half day)
• Must be available during standard business hours (Monday-Friday) for the first 4 weeks of training