RN - 37530399
Innova Solutions•Pittsburgh, PA
•Remote
About The Position
Prime HCS is seeking an experienced RN for a long-term, fully remote Care Management Coordinator contract. In this role, you will review medical records and clinical information to determine medical necessity and appropriateness of services using established clinical guidelines, including InterQual. You will also support discharge planning, communicate with providers as needed, authorize medically appropriate services, and refer cases requiring additional review to the Medical Director.
Requirements
- Active Pennsylvania RN license required
- Minimum 3 years of Medical-Surgical clinical experience
- Discharge planning experience required
- At least 3-years total experience in your specialty
- Current BLS and/or ACLS (AHA Preferred) and/or Specialty Certifications
- Active Nursing License per state
- Current Updated Resume
- Supervisory Professional References
- Must complete Drug Screen and Background Screen
Nice To Haves
- BSN preferred
- Utilization management or InterQual experience preferred
- Medical management or precertification experience is a plus
Responsibilities
- Review medical records and clinical information to determine medical necessity and appropriateness of services using established clinical guidelines, including InterQual.
- Support discharge planning.
- Communicate with providers as needed.
- Authorize medically appropriate services.
- Refer cases requiring additional review to the Medical Director.
Benefits
- First Day Medical, Dental, Vision and Rx benefits
- 401(k) Savings plan after 90 days
- Competitive pay rates
- Weekly Direct Deposit
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
