CAREER PORTAL

RN Care Coordinators

RN Care Coordinator  needed for a remote   contract opportunity with Yoh’s client located in Philadelphia, PA. We are looking for a nurse to join the Clinical Precert Team.

*This is a REMOTE position, however, a PA nursing license is REQUIRED.

Schedule: Monday - Friday 8am-4:30pm
Duration:  6 months with possible extension or direct placement
Pay:$32-40/hr DOE

What You’ll Be Doing:

• Applies 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 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 physician to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting.
• Reports potential utilization issues or trends to designated manager and recommendations for improvement.
• 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 request is covered within the member’s benefit plan.    
• Ensures utilization decisions are compliant with state, federal and accreditation regulations.
• Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests.
• Ensures that all key functions are documented via Care Management and Coordination Policy.
• Maintains the integrity of the system information by timely, accurate data entry.
• Performs additional duties assigned.

What You Need to Bring to the Table:

• Active PA RN or LPN License (BSN Preferred)
• Acute care clinical experience in a hospital or other health care setting
• Prior discharge planning and/or utilization management experience is desirable
• Medical management/precertification experience preferred
• Proficiency utilizing Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs with an ability to learn new systems as technology advances

What’s In It For You

• Join Yoh’s extensive talent community that will provide you with access to Yoh’s vast network of opportunities.
• Weekends and holidays off
• Direct deposit & weekly epayroll

 
APPLY NOW!
Recruiter: Laura Mopas
 


Estimated Min Rate: $32.00
Estimated Max Rate: $40.00

Note: Any pay ranges displayed are estimations.  Actual pay is determined by an applicant's experience, technical expertise, and other qualifications as listed in the job description.  All qualified applicants are welcome to apply.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Visit  https://www.yoh.com/applicants-with-disabilities  to contact us if you are an individual with a disability and require accommodation in the application process.

For California applicants, qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.  All of the material job duties described in this posting are job duties for which a criminal history may have a direct, adverse, and negative relationship potentially resulting in the withdrawal of a conditional offer of employment.