Local Contract Nurse RN - Care Manager - $40-45 per hourPyramid Consulting • Philadelphia, PA, United States

Local Contract Nurse RN - Care Manager - $40-45 per hour

Pyramid Consulting • Philadelphia, PA, United States

1 day ago

Job type

Full-time

Job description

Pyramid Consulting is seeking a local contract nurse RN Care Manager for a local contract nursing job in Philadelphia, Pennsylvania.

Job Description & Requirements

Specialty : Care Manager
Discipline : RN
Start Date : 12 / 15 / 2025
Duration : 13 weeks
40 hours per week
Shift : 8 hours, days
Employment Type : Local Contract

Job Title : Care Management Coordinator RN

Location : Remote

Shift : Days

Duration : 13 Weeks

Job Summary

The Care Management Coordinator primary responsibility is to evaluate a member’s clinical condition through the review of medical records (including medical history and treatment records) to determine the medical necessity for patient’s services based on advanced knowledge and independent analysis of those medical records and application of appropriate medical necessity criteria.

If necessary, the Care Management Coordinator directly interact with providers to obtain additional clinical information.

The Care Management Coordinator has the authority to commit the company financially by independently authorizing services determined to be medically necessary based on their personal review.

For those cases that do not meet established criteria, the Care Management Coordinator provides relevant information regarding members medical condition to the Medical Director for their further review and evaluation.

The Care Management Coordinator has the authority to approve but cannot deny the care for patients. The Care Management Coordinator is also responsible for maintaining regulatory compliance with federal, state and accreditation regulations.

Additionally, the Care Management Coordinator acts a patient advocate and a resource for members when accessing and navigating the health care system.

Key Responsibilities

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 of InterQual and / or Medical Policy to establish the need for inpatient, continued stay and length of stay, procedures and ancillary services.

Note : InterQual - It is the policy of the Medical Affairs Utilization Management (UM) Department to use InterQual (IQ) criteria for the case review process when required. IQ criteria are objective clinical statements that assist in determining the medical appropriateness of a proposed intervention which is a combination of evidence-based standards of care, current practices, and consensus from licensed specialists and / or primary care physicians. IQ criteria are used as a screening tool to support a clinical rationale for decision making.

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.

Qualifications :

Active PA Licensed RN

BSN Preferred

Minimum of three (3) years of Medical / Surgical experience.

Previous Acute Hospital Utilization management / IQ experience

Knowledge, & Skills

Exceptional communication, problem solving, and interpersonal skills.

Action oriented with strong ability to set priorities and obtain results.

Team Player - builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy.

Open to change, comfortable with new ideas and methods; creates and acts on new opportunities; is flexible and adaptable.

Embrace the diversity of our workforce and show respect for our colleagues internally and externally.

Excellent organizational planning and prioritizing skills.

Ability to effectively utilize time management.

Oriented in current trends of medical practice.

Proficiency utilizing Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs. Ability to learn new systems as technology advances.

This is a remote position, if you reside in the tri-state area (NJ, DE or PA) feel free to get in touch and we can discuss about the role in detail.

About Pyramid Consulting

Supercharge your career with Pyramid Consulting.

We are dedicated to accelerating growth, creating opportunities, and fostering an environment built on belonging, trust, and mutual respect. Our commitment is to help you find the best path to achieve your career goals.

As a global leader in workforce and technology solutions, Pyramid Consulting, Inc. partners with clients to navigate competitive and ever-changing markets. Our award-winning family of brands — Pyramid Talent, Celsior, and GenSpark — works seamlessly together, delivering integrated solutions through multiple delivery models across five continents and 25+ countries. Since our founding in 1996, we’ve supported 125+ Fortune 500 companies across all major industries by engaging 6,500+ consultants worldwide.

Join our talent network

Looking for a job that aligns with your skills and ambitions? Join our talent network and enhance your job search experience with access to a broad range of job opportunities tailored to your background and interests.

Explore jobs : Visit our job portal to browse positions that suit your preferences. You can filter jobs by role, location, or industry to find the best match.

Apply : Submit your application and upload your resume through our portal. Our recruiters will reach out to discuss your career goals and help connect you with the right opportunities.

Take the next step in your career journey with Pyramid Consulting, where we’re committed to helping you grow and succeed.

Create a job alert for this search

Nurse Rn Care Manager • Philadelphia, PA, United States

Related jobs

Local Contract Nurse RN - Acute Care - $60-62 per hour

WCS Healthcare Partners • Camden, NJ, United States

Full-time

Local Contract Nurse RN - Acute Care - $60-62 per hour at WCS Healthcare Partners summary : .This position is for a local contract Registered Nurse specializing in Acute Care to work a 13-week night ...Show more

Last updated: 13 hours ago • Promoted • New!

Local Contract ICU Registered Nurse - $61 per hour

Stability Healthcare • Philadelphia, Pennsylvania, United States

Full-time

Stability Healthcare is seeking a local contract nurse RN ICU - Intensive Care Unit for a local contract nursing job in Philadelphia, Pennsylvania. Job Description & Requirements.ICU - Intensive Car...Show more

Last updated: 3 hours ago • Promoted • New!

Local Contract Nurse RN - Long Term Acute Care - $48 per hour

Supplemental Health Care • Willingboro, NJ, United States

Full-time +1

Supplemental Health Care is seeking a local contract nurse RN Long Term Acute Care for a local contract nursing job in Willingboro, New Jersey. Job Description & Requirements.Supplemental Health Car...Show more

Last updated: 25 days ago • Promoted

Local Contract Nurse RN - CVICU - $47-51 per hour

Host Healthcare • Philadelphia, PA, United States

Full-time

Host Healthcare is seeking a local contract nurse RN CVICU for a local contract nursing job in Philadelphia, Pennsylvania. Job Description & Requirements.Local Contract CVICU Nursing Job.Philadelphi...Show more

Last updated: 30+ days ago • Promoted

Local LTAC RN Job in Willingboro, New Jersey

Gifted Healthcare • Blackwood, NJ, US

Full-time

Long Term Acute Care RNs (LTAC RNs) provide quality patient care during the patient assessment, intervention, and evaluation process. LTAC RNs collaborate with all members of a patient's healthc...Show more

Last updated: 30+ days ago • Promoted

Local Contract Nurse RN - Care Manager - $40-45 per hour

Pyramid Consulting • Philadelphia, PA, United States

Full-time

Pyramid Consulting is seeking a local contract nurse RN Care Manager for a local contract nursing job in Philadelphia, Pennsylvania. Job Description & Requirements.Job Title : Care Management Coordin...Show more

Last updated: 1 day ago • Promoted

Local Contract Nurse RN - CVOR - $75 per hour

GHR Healthcare - Travel Division • Camden, NJ, USA

Full-time

Local Contract Nurse RN - CVOR - $75 per hour at GHR Healthcare - Travel Division summary : .GHR Healthcare is seeking a local contract RN specializing in CVOR for a nursing position in Camden, New J...Show more

Last updated: 30+ days ago • Promoted

Local Contract Nurse RN - Ambulatory Care - $40 per hour

TalentBurst, Inc • Philadelphia, PA, USA

Full-time

TalentBurst, Inc is seeking a local contract nurse RN Ambulatory Care for a local contract nursing job in Philadelphia, Pennsylvania. Job Description & Requirements.Schwenksville, PA 19473 / Collegev...Show more

Last updated: 30+ days ago • Promoted

Travel Nurse RN - Home Health - $2,240 per week in Lancaster, PA

TravelNurseSource • Philadelphia, Pennsylvania, US

Full-time +1

TravelNurseSource is working with Core Medical Group to find a qualified Home Health RN in Lancaster, Pennsylvania, 17602!. Client in PA seeking Registered Nurse : Home Health.We are looking for a he...Show more

Last updated: 30+ days ago • Promoted

Local Contract ICU Registered Nurse - $52-61 per hour

Medical Solutions • Philadelphia, PA, United States

Full-time

Medical Solutions is seeking a local contract nurse RN ICU - Intensive Care Unit for a local contract nursing job in Philadelphia, Pennsylvania. Job Description & Requirements.We’re seeking talented...Show more

Last updated: 1 day ago • Promoted

Local Contract Nurse RN - Home Health - $55-60 per hour

Custom Healthcare Solutions • Cherry Hill, NJ, USA

Full-time

Custom Healthcare Solutions is seeking a local contract nurse RN Home Health for a local contract nursing job in Cherry Hill, New Jersey. Job Description & Requirements.M-F 8 : 30am - 5 : 00pm Home Heal...Show more

Last updated: 30+ days ago • Promoted

Local Contract Nurse RN - Telemetry - $63 per hour

Ethos Medical Staffing • Gibbsboro, NJ, United States

Full-time

Ethos Medical Staffing is seeking a local contract nurse RN Telemetry for a local contract nursing job in Voorhees, New Jersey. Job Description & Requirements Specialty : Telemetry Discipline : RN Sta...Show more

Last updated: 19 hours ago • Promoted • New!

Travel Nurse RN - Long-Term Care - $2,208 per week in Stroudsburg, PA

TravelNurseSource • Philadelphia, Pennsylvania, US

Full-time

TravelNurseSource is working with Medical Solutions to find a qualified Long-Term Care RN in Stroudsburg, Pennsylvania, 18360!. A facility in Stroudsburg, PA is seeking its next amazing RN (Register...Show more

Last updated: 16 hours ago • Promoted • New!

Local Contract Nurse RN - Long Term Care - $45 per hour

TalentBurst • Elkins Park, PA, United States

Full-time

TalentBurst, Inc is seeking a local contract nurse RN Long Term Care for a local contract nursing job in Philadelphia, Pennsylvania. Job Description & Requirements Specialty : Long Term Care Discipli...Show more

Last updated: 19 hours ago • Promoted • New!

Local Contract Nurse RN - Acute Care - $60-63 per hour

WCS Healthcare Partners • Willingboro, NJ, United States

Full-time

Local Contract Nurse RN - Acute Care - $60-63 per hour at WCS Healthcare Partners summary : .This position is for a local contract Registered Nurse (RN) specializing in Acute Care at a hospital in Wi...Show more

Last updated: 1 day ago • Promoted

Local Contract Nurse RN - Dialysis - $50-60 per hour

HeartCentrix Solutions • Philadelphia, PA, United States

Full-time

HeartCentrix Solutions is seeking a local contract nurse RN Dialysis for a local contract nursing job in Philadelphia, Pennsylvania. Job Description & Requirements.WORK SCHEDULE : Shifts may vary bet...Show more

Last updated: 30+ days ago • Promoted

Local Contract Nurse RN - Dialysis - $48-51 per hour

Healthcare Support • Philadelphia, PA, USA

Permanent

Local Contract Nurse RN - Dialysis - $48-51 per hour at Healthcare Support summary : .The Local Contract Nurse RN specializing in Dialysis provides critical nursing care for patients undergoing chron...Show more

Last updated: 30+ days ago • Promoted

Local Contract Nurse RN - Interventional Radiology - $62-66 per hour

Host Healthcare • Philadelphia, PA, United States

Full-time

Host Healthcare is seeking a local contract nurse RN Interventional Radiology for a local contract nursing job in Philadelphia, Pennsylvania. Job Description & Requirements.Host Healthcare Job ID #L...Show more

Last updated: 30+ days ago • Promoted