Remote RN Care Management Coordinator – Pennsylvania

JOB TITLE: RN Care Management Coordinator

Location: Remote, but candidates must reside in the tri-state area for potential conversion.

DEPARTMENT: Care Management and Coordination

Licensure: PA RN license required

Experience: Post-acute care experience required

GENERAL SUMMARY

The Care Management Coordinator, under the supervision of the Care Management and Coordination Supervisor, plays a crucial role in enhancing healthcare delivery by performing telephonic or onsite reviews of hospital admissions and recommending alternative care settings when appropriate. This role focuses on optimizing patient outcomes through efficient and high-quality healthcare utilization, ensuring timely discharge planning, and collaborating with the case management team when necessary. The Coordinator will work closely with hospital utilization departments, attending physicians, and patients’ families to ensure the most effective and patient-centered care is provided.

KEY RESPONSIBILITIES

• Conduct utilization management reviews for inpatient admissions, both telephonically and onsite.
• Evaluate the need for inpatient admission, continued stay, and appropriate length of stay using medical software criteria.
• Direct patient care to the most suitable and cost-effective setting while maintaining care quality.
• Communicate with attending physicians to clarify treatment plans and assess the necessity of inpatient or continued care.
• Identify cases where inpatient admissions no longer meet criteria and refer them to the Medical Director for further evaluation.
• Present cases that do not meet established criteria to Medical Directors, providing relevant information on the patient’s medical condition and post-discharge care needs.
• Collaborate with hospital case management, physicians, and family members to facilitate timely and appropriate discharge planning.
• Refer cases to case management or disease management as needed.
• Identify and report any delays in care or quality of care issues to the Quality Management Department or Supervisor.
• Ensure timely and accurate data entry, maintaining compliance with state, federal, and accreditation standards.
• Build strong relationships with healthcare providers and deliver exceptional customer service.
• Identify and report utilization trends or potential issues to the Supervisor, along with suggestions for improvement.
• Educate providers on managed care protocols.
• Perform additional duties as assigned.

QUALIFICATIONS

• Education: RN required, BSN preferred.
• Experience: Minimum of 3 years of acute care clinical experience in a hospital or healthcare setting. Prior experience in discharge planning or utilization management is highly desirable.
• Licensure: Valid PA RN license.
• Additional: Driver’s license and reliable access to transportation are required.

SKILLS & ABILITIES

• Excellent communication and interpersonal skills across all levels.
• Strong problem-solving abilities and critical thinking.
• Highly organized with exceptional team management skills.
• Collaborative team player, with the ability to work effectively across departments.