Innova Solutions · 16 hours ago
Care Management Coordinator/RN
Philadelphia, PA
Contract
Onsite
Mid Level
$41/hr - $45/hr
3+ years expInnova Solutions has a client that is immediately hiring for a Care Management Coordinator/RN. The role involves applying critical thinking and medical knowledge to assess cases and determine the appropriateness of treatment plans while collaborating with providers and case management staff.
Artificial Intelligence (AI)Business Information SystemsCloud Data ServicesConsultingCyber SecurityInformation TechnologyInfrastructureIT ManagementMachine LearningSoftware
Responsibilities
Responsible for applying critical thinking and judgement skills based on advanced medical knowledge to cases utilizing specified resources and guidelines to make case determination
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
Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Director for further evaluation determination
Performs early identification of members to evaluate discharge planning needs
Collaborates with case management staff or physicians to determine alternative settings at times and provide support to facilitate discharge to the most appropriate setting
Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Manager when indicated to include delays in care
Appropriately refers cases to Case and Disease Management
Ensures utilization decisions are compliant with state, federal and accreditation regulations
Ensures that all key functions are documented via Care Management and Coordination Policy
Qualification
Required
Minimum of three (3) years of Medical/Surgical experience
Previous Acute Hospital Utilization management/ IQ experience
Active PA Licensed RN
Proficiency utilizing Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs. Ability to learn new systems as technology advances
Preferred
BSN Preferred
Medical management/precertification experience preferred
Prior discharge planning and/or utilization management, InterQual or Millman/Robert's experience is preferred
Benefits
Medical & pharmacy coverage
Dental/vision insurance
401(k)
Health saving account (HSA)
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
Other types of paid leaves (as required by law)
Employee Assistance Program (EAP)
Company
Innova Solutions
Innova Solutions is an IT company that specializes in data analytics, cloud computing, cyber security, and machine learning.
10001+ employees
H1B Sponsorship
Innova Solutions has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (452)
2024 (399)
2023 (290)
2022 (78)
2021 (36)
2020 (98)
Funding
Current Stage
Late StageTotal Funding
unknown2012-01-01Private Equity
Leadership Team
Raj Sardana
Founder, Chairman, & CEO
A
Atul Gambhir
Chief Information & Product Officer
Recent News
2025-12-15
EIN Presswire
2025-08-01
Company data provided by crunchbase