Care Management Coordinator RN

3 weeks ago


Philadelphia, Pennsylvania, United States Blue Cross and Blue Shield Association Full time
Care Management Coordinator RN Job Description

At Blue Cross and Blue Shield Association, we're seeking a highly skilled Care Management Coordinator RN to join our team. As a key member of our care management team, you will play a critical role in evaluating patient needs and ensuring that our members receive the most appropriate care.

Key Responsibilities:
  • Apply advanced medical knowledge to evaluate patient cases and determine medical necessity for services.
  • Utilize InterQual and medical policy to establish the need for inpatient, continued stay, and length of stay, procedures, and ancillary services.
  • Collaborate with healthcare providers to clarify medical information and ensure that treatment plans meet established criteria.
  • Identify and refer cases that do not meet established criteria to the Medical Director for further evaluation and determination.
  • Perform early identification of members who require discharge planning and collaborate with case management staff and physicians to determine alternative settings.
  • Report potential utilization issues or trends to designated managers and provide recommendations for improvement.
Requirements:
  • Active PA Licensed RN
  • Minimum of three (3) years of acute care clinical experience in a hospital or other healthcare setting
  • Prior discharge planning and/or utilization management experience is desirable

We offer a dynamic and supportive work environment, with opportunities for professional growth and development. If you're a motivated and detail-oriented individual with a passion for delivering high-quality patient care, we encourage you to apply for this exciting opportunity.



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