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

14 hours 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.

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Nurse Rn Care Manager • Philadelphia, PA, United States

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