Care Management Coordinator/RN

Full-time contract position (3 months), based in Philadelphia, PA 19103 (remote).

About the role

As an RN Case Manager, you will apply critical thinking and judgment skills based on advanced medical knowledge to cases utilizing specified resources and guidelines to make case determinations.

Responsibilities

• Utilize resources such as InterQual, Care Management Policy, Medical Policy, and Electronic Desk References to determine the medical appropriateness of the proposed plan.
• Utilize 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.
• Contact servicing providers regarding treatment plans/plan of care and clarify medical need for services.
• Perform early identification of members to evaluate discharge planning needs.
• Collaborate with case management staff or physicians to determine alternative settings and provide support to facilitate discharge to the most appropriate setting.
• Report on potential utilization issues or trends to designated managers with recommendations for improvement.
• Appropriately refer cases to the Quality Management Department and/or Care Management and Coordination Manager when indicated, including delays in care.
• Appropriately refer to Case and Disease Management.
• Ensure requests are covered within the member’s benefit plan.

Requirements

• Active Pennsylvania RN license or Nurse Licensure Compact license that includes Pennsylvania.
• Prior authorization experience.

Pay

Pay range: $40–$45 per hour (actual offer based on education, experience, location, job duties, certifications, etc.).

Benefits

• Medical & pharmacy coverage
• Dental/vision insurance
• 401(k)
• Health Savings Account (HSA) and Flexible Spending Account (FSA)
• Life Insurance
• Pet Insurance
• Short-term and Long-term Disability
• Accident & Critical Illness coverage
• Pre-paid legal & ID theft protection
• Sick time and other paid leaves (as required by law)
• Employee Assistance Program (EAP)

Schedule

Full-time, 3-month contract.

About the Company

Innova Solutions, founded in 1998 and headquartered in Atlanta, Georgia, employs approximately 50,000 professionals worldwide with annual revenue approaching $3 billion. The company delivers strategic technology and business transformation solutions through global delivery centers across North America, Asia, and Europe.

Recent recognitions include: Forbes' America’s Best Employers for New Grads (2024); U.S. News & World Report Best Companies to Work For (Private Companies List, 2024-2025); Staffing Industry Analysts rankings: #3 Largest IT Staffing Firms in the US (2024), #13 Largest Staffing Firms in the US (2024); Atlanta Business Chronicle Top Ten Private Companies in Atlanta (2023); NMSDC Largest Certified Minority Business Enterprises (2024); AWS Advanced Tier Services Partner with 100+ certifications.

Website: https://www.innovasolutions.com/