Registered Nurse Care Manager – Utilization Management

Trinity Health • Darby, PA

13d • Onsite

About The Position

Mercy Fitzgerald is seeking a dedicated RN Care Manager – Utilization Management to join our Care Coordination team. Under the general supervision of the Manager of Care Coordination, this role supports the delivery of effective and efficient patient care by ensuring appropriate utilization of resources and reimbursement. The RN Care Manager is accountable for utilization management within an assigned caseload and collaborates with the healthcare team to confirm medical necessity for admission and continued stay.

Requirements

• Bachelors of Science in Nursing (BSN) required.
• Active Registered Nurse license in the State of Pennsylvania required.
• Minimum of 3 years of clinical experience, with emphasis on medical/surgical nursing.
• Knowledge of managed care, government payers, and third-party reimbursement.
• Proficiency in Microsoft Office applications.
• Strong interpersonal, oral, and written communication skills.
• Ability to document effectively in electronic health records.

Nice To Haves

• Case Management certification from an accredited organization preferred.
• Experience in Case Management, Discharge Planning, and Utilization Management preferred.
• Familiarity with InterQual criteria and MIDAS system preferred.

Responsibilities

• Perform clinically based utilization reviews to support efficient patient care delivery.
• Apply InterQual criteria to confirm medical necessity for inpatient admission and continued stay.
• Collaborate with physicians, nurses, and other healthcare professionals to ensure appropriate resource use and reimbursement.
• Screen patients for Intensive Case Management programs, including disease management and discharge planning.
• Monitor patient progress and outcomes to support high-quality, cost-effective care.
• Document findings and interventions in the electronic health record and clinical databases.

Benefits

• Comprehensive benefit packages, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from the first day of employment.
• Work/Life balance with flexible schedules.
• Free onsite parking.
• Referral Rewards Program

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level