What are the responsibilities and job description for the Care Management Coordinator/RN position at IntePros?
Utilization Management RN
Location: Remote – must reside in Pennsylvania, Delaware, or New Jersey
License Requirement: Active PA RN license or Nurse Licensure Compact that includes Pennsylvania
Position Overview
The Care Management Coordinator (RN) is responsible for evaluating members’ clinical conditions through comprehensive review of medical records to determine medical necessity and appropriateness of care. This role involves applying evidence-based criteria, collaborating with providers to obtain supporting documentation, and authorizing services that meet established guidelines. Acting as both a clinical reviewer and patient advocate, the Care Management Coordinator ensures members receive high-quality, cost-effective care while maintaining full compliance with all regulatory standards.
Key Responsibilities
Education
This is a remote opportunity offering the chance to make a meaningful impact on patient outcomes while working collaboratively in a supportive and mission-driven environment. You’ll leverage your clinical expertise to ensure members receive the right care, at the right time, and in the right setting.
Location: Remote – must reside in Pennsylvania, Delaware, or New Jersey
License Requirement: Active PA RN license or Nurse Licensure Compact that includes Pennsylvania
Position Overview
The Care Management Coordinator (RN) is responsible for evaluating members’ clinical conditions through comprehensive review of medical records to determine medical necessity and appropriateness of care. This role involves applying evidence-based criteria, collaborating with providers to obtain supporting documentation, and authorizing services that meet established guidelines. Acting as both a clinical reviewer and patient advocate, the Care Management Coordinator ensures members receive high-quality, cost-effective care while maintaining full compliance with all regulatory standards.
Key Responsibilities
- Apply critical thinking and clinical judgment to evaluate medical necessity using established criteria and policies, including InterQual, Care Management Policy, and Medical Policy.
- Review medical records, treatment plans, and service requests for inpatient, outpatient, and ancillary services.
- Contact providers to clarify or obtain additional clinical information when needed.
- Approve medically necessary services in alignment with benefit coverage, policy, and regulatory standards.
- Refer cases not meeting criteria to the Medical Director for secondary review.
- Identify members with discharge planning needs and collaborate with case management or physicians to ensure appropriate care transitions.
- Report utilization trends, care delays, or quality concerns to leadership as appropriate.
- Partner with Case Management, Disease Management, and Quality Management teams to ensure coordinated care delivery.
- Maintain accurate and timely documentation in all systems and adhere to departmental turnaround and productivity standards.
- Ensure compliance with federal, state, and accreditation requirements in all utilization decisions.
Education
- Active Registered Nurse (RN) license in Pennsylvania or a Nurse Licensure Compact state including PA required
- BSN preferred
- Minimum of three (3) years of clinical experience in a hospital or other healthcare setting; Neonatal Intensive Care experience strongly preferred
- Prior discharge planning, utilization management, or medical management/precertification experience desirable
- Strong clinical assessment and analytical skills with ability to apply medical necessity criteria (e.g., InterQual).
- Excellent communication, problem-solving, and interpersonal skills for collaborating with providers and internal teams.
- Highly organized with proven ability to manage competing priorities and meet deadlines.
- Proficient in Microsoft Word, Outlook, Excel, SharePoint, and Adobe; able to learn new systems and technologies quickly.
- Flexible, adaptable, and open to process improvements and new methods.
- Demonstrated ability to uphold professional and ethical standards while advocating for members’ care needs.
This is a remote opportunity offering the chance to make a meaningful impact on patient outcomes while working collaboratively in a supportive and mission-driven environment. You’ll leverage your clinical expertise to ensure members receive the right care, at the right time, and in the right setting.