Care Management RN – NICU

Care Management RN

Location: Remote (must reside in PA, DE, or NJ) 
Schedule: Monday–Friday, Day Shift 
Compensation: Up to $45/hour 
Employment Type: Full-time

About the Role

We’re seeking a highly skilled and compassionate Care Management RN with Med/Surg experience to join our remote team. In this role, you’ll evaluate clinical conditions, review medical records, and determine medical necessity for services using evidence-based criteria. You’ll collaborate with providers, advocate for patients, and ensure compliance with regulatory standards.

Responsibilities

• Clinical Review & Decision-Making:
• Apply critical thinking and advanced medical knowledge to evaluate cases using InterQual, medical policy, and care management guidelines.
• Determine medical appropriateness for inpatient admissions, procedures, and ancillary services.
• Communicate with providers to clarify treatment plans and medical necessity.
• Care Coordination & Advocacy:
• Identify discharge planning needs early and collaborate with case managers and physicians.
• Refer cases to Medical Director when criteria are not met.
• Ensure services align with member benefits and regulatory requirements.
• Compliance & Documentation:
• Maintain accurate documentation per Care Management and Coordination Policy.
• Meet regulatory turnaround times and productivity goals.
• Report utilization trends and refer cases to Quality Management or Disease Management as needed.

Required Skills & Knowledge

• Strong communication, problem-solving, and interpersonal skills
• Ability to prioritize, manage time effectively, and adapt to change
• Team-oriented with a collaborative mindset
• Proficient in Microsoft Word, Outlook, Excel, SharePoint, and Adobe
• Familiarity with current medical practices and trends

Qualifications

• Active RN license in Pennsylvania or Nurse Licensure Compact including PA
• BSN preferred
• Minimum of 3 years of Med/Surg clinical experience in a hospital or healthcare setting
• Prior discharge planning and/or utilization management, Interqual or Millman/Robert’s experience is preferred