Care Management Coordinator/RN

Innova Solutions•Philadelphia, PA

8d•Onsite

About The Position

Innova Solutions is seeking a Utilization Management RN for a part-time, contract position lasting three months in Philadelphia, PA. In this role, you will utilize resources such as InterQual, Care Management Policy, Medical Policy, and Electronic Desk References to determine the medical appropriateness of proposed plans. You will establish the need for inpatient care, continued stay, length of stay, procedures, and ancillary services based on medical criteria. You will also contact servicing providers to discuss treatment plans and clarify medical needs, collaborating with case management staff or physicians to identify alternative settings and facilitate discharge to the most appropriate environment. Maintaining accurate and timely data entry in the Care Management and Coordination Policy system is crucial.

Requirements

Active PA RN license or compact license to include PA.
Minimum of three (3) years of Medical Surgical clinical experience in a hospital or other health care setting.
Prior discharge planning and/or utilization management experience.

Nice To Haves

InterQual or Millman/Robert’s experience.
BSN

Responsibilities

Utilizes resources such as; InterQual, Care Management Policy, Medical Policy and Electronic Desk References to determine the medical appropriateness of the proposed plan.
Utilizes the medical criteria of InterQual and/or Medical Policy to establish the need for inpatient, continued stay and length of stay, procedures and ancillary services.
Contacts servicing providers regarding treatment plans/plan of care and clarifies medical need for services.
Reviews treatment plans/plan of care with provider for requested services/procedures, inpatient admissions or continued stay, clarifying medical information with provider if needed.
Collaborate with case management staff or physician to determine alternative settings at times and provide support to facilitate discharge to the most appropriate setting.
Ensures that all key functions are documented via Care Management and Coordination Policy.
Maintains the integrity of the system information by timely, accurate data entry.