IntePros · 7 hours ago
Care Management Coordinator (RN)
United States
Contract
Remote
Mid Level
3+ years expIntePros is seeking a Care Management Coordinator (RN) to evaluate members’ clinical conditions and determine the medical necessity of healthcare services. This role involves comprehensive medical record review, collaboration with providers, and authorizing medically necessary services while ensuring regulatory compliance.
ConsultingInformation TechnologyStaffing Agency
Responsibilities
Conduct detailed reviews of medical records, including medical history and treatment documentation
Apply advanced clinical judgment and independent analysis to determine medical necessity
Utilize InterQual, Medical Policy, Care Management Policy, and Electronic Desk References to support utilization decisions
Establish medical appropriateness for inpatient admissions, continued stays, length of stay, procedures, and ancillary services
Communicate directly with servicing providers to clarify treatment plans and medical necessity
Review plans of care and request additional clinical information as needed
Refer cases that do not meet established criteria to the Medical Director for further evaluation
Authorize care when criteria are met; escalate only when required (authority to approve but not deny care)
Identify members early for discharge planning needs
Collaborate with case management staff and physicians to support discharge to the most appropriate level of care
Refer members to Case Management, Disease Management, or Quality Management as appropriate
Ensure utilization decisions comply with state, federal, and accreditation regulations
Meet or exceed regulatory turnaround times and departmental productivity standards
Maintain accurate, timely documentation in accordance with Care Management policies
Ensure benefit coverage aligns with member benefit plans
Identify and report utilization trends or potential issues, providing recommendations for improvement
Qualification
Required
Active Pennsylvania RN license required
Nurse Licensure Compact (NLC) including PA accepted
Minimum 3 years of Medical/Surgical nursing experience
Prior Acute Hospital Utilization Management experience
Strong working knowledge of InterQual (IQ) criteria
Strong clinical judgment, critical thinking, and problem-solving skills
Excellent verbal and written communication abilities
Highly organized with strong time management and prioritization skills
Collaborative team player with the ability to build strong cross-functional relationships
Adaptable and open to change in a fast-paced environment
Knowledge of current medical practice trends
Proficiency with Microsoft Word, Outlook, Excel, SharePoint, and Adobe tools
Ability to learn new systems and adapt to evolving technology
100% Remote, candidates must reside in PA, DE, or NJ
Full-time hours during standard business operations
Collaborative, mission-driven healthcare environment
Preferred
BSN preferred
Company
IntePros
IntePros is an established, woman-owned, privately-held technology and business services consulting agency committed to building long-term relationships and helping more companies leverage the power of a more diverse workforce.
201-500 employees
H1B Sponsorship
IntePros 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 (3)
2024 (3)
2023 (6)
2022 (7)
2021 (6)
2020 (13)
Funding
Current Stage
Growth StageLeadership Team
Loren Kovalcik
CEO
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