Job Description

GHR has a wonderful, fully remote RN Care Management Coordinator opportunity for a Registered Nurse in PA, DE or NJ!

**Prior utilization review experience required.**

** Candidates MUST live in PA, DE, or NJ and must have multistate RN license or PA single state.**

For more information on this and our other Registered Nurse (RN) opportunities, please call/text Lexie at 610-684-4716 or email agleason@GHRhealthcare.com.

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Registered Nurse Job Details:

• Pay Rate: Starting at $40/hour
• Schedule: Monday-Friday 8am-5pm, possible every 3rd Saturday rotation
• Benefits: Medical, dental, vision, 401k, employee assistance program

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Job Summary :

The Care Management Coordinator reviews medical records to assess clinical conditions and determine medical necessity using established criteria. They may contact providers for additional information and have the authority to independently approve medically necessary services. Cases not meeting criteria are escalated to the Medical Director. The role ensures compliance with all regulatory requirements and serves as a patient advocate, helping members navigate the healthcare system.

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Key Responsibilities :

• Apply critical thinking and advanced clinical knowledge, using InterQual, medical policy, and UM guidelines to make medical necessity determinations.
• Determine appropriateness of inpatient admissions, continued stay, length of stay, procedures, and ancillary services.
• Review and clarify treatment plans with servicing providers and obtain needed clinical information.
• Identify cases that do not meet criteria and refer appropriately to the Medical Director, Quality Management, or Case/Disease Management.
• Perform early identification of discharge planning needs and collaborate with case management/physicians to coordinate the most appropriate care setting.
• Ensure requests are covered under members’ benefit plans and comply with federal, state, and accreditation requirements.
• Meet regulatory turnaround times and departmental productivity standards while maintaining accurate, timely documentation in Care Management systems.
• Identify and report utilization trends and perform other related duties as assigned.

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Registered Nurse Job Requirements:

(PLEASE only apply if you meet the requirements)

• Active, unencumbered PA RN License
• Minimum 2 years of prior utilization review experience

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About Us

At GHR Healthcare, we place Registered Nurses (RN), LVN/LPNs, therapists, pharmacists, behavioral health and school-based professionals in per diem, long-term and permanent positions. We offer great pay and one of the best benefits packages in the industry, including:

• Flexible scheduling options
• Personalized service
• Health insurance
• 401(k) investment plan
• Referral bonuses
• Free liability insurance coverage
• Weekly pay
• Direct Deposit or Pay Card option

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Job Type: Full-time

Pay: From $40.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Referral program
• Vision insurance

Work Location: Remote

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