RN, HEDIS, PA, Harrisburg,

GHR has a wonderful, fully remote RN Care Management Coordinator opportunity for a Registered Nurse in PA, DE or NJ!


**Prior insurance or hospital utilization review experience required.**


** Candidates MUST live in PA, DE, or NJ and must have multistate RN license or PA single state.**


For more information on this and our other Registered Nurse (RN) opportunities, please call/text Erin at View phone number on click.appcast.io.


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Registered Nurse Job Details:

• Pay Rate: Starting at $40/hour
• Schedule: Monday-Friday 8:45-5pm
• Benefits: Medical, dental, vision, 401k, employee assistant program

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Job Summary :

• Performs utilization management for inpatient admissions both onsite and telephonically.
• Utilizes medical necessity criteria within software systems to determine need for inpatient admission, continued stay, and appropriate length of stay.
• Directs patient care to the most appropriate level and setting while maintaining quality standards.
• Communicates with attending physicians to review treatment plans, clarify plan of care, and confirm medical necessity for inpatient or continued inpatient care.
• Identifies admissions that no longer meet criteria and escalates cases to Medical Directors for further evaluation.
• Presents cases that do not meet established criteria to Medical Directors, providing detailed clinical information and potential home care or discharge needs.
• Conducts early identification of hospitalized members to assess discharge planning requirements.
• Collaborates with hospital case management teams, physicians, and families to coordinate alternative care settings and facilitate appropriate discharge planning.
• Identifies and refers appropriate cases for case management and disease management programs.
• Recognizes and reports quality-of-care concerns, including delays in care, and refers cases to the Quality Management Department or Care Management and Coordination Supervisor when appropriate.
• Maintains system integrity through timely and accurate documentation and data entry, ensuring utilization decisions comply with state, federal, and accreditation regulations.
• Builds strong relationships with healthcare providers while delivering exceptional customer service.
• Reports potential utilization trends or concerns to leadership and recommends process improvements.
• Participates in provider education related to managed care processes and requirements.
• Completes additional duties and responsibilities as assigned.

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Registered Nurse Job Requirements:


(PLEASE only apply if you meet the requirements)

• Active, unencumbered PA RN License
• Prior insurance or hospital utilization review experience

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About Us


At GHR Healthcare, we place Registered Nurses (RN), LVN/LPNs, therapists, pharmacists, behavioral health and school-based professionals in per diem, long-term and permanent positions. We offer great pay and one of the best benefits packages in the industry, including:

• Flexible scheduling options
• Personalized service
• Health insurance
• 401(k) investment plan
• Referral bonuses
• Free liability insurance coverage
• Weekly pay
• Direct Deposit or Pay Card option

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.


Job Types: Full-time, Contract, Temporary

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Referral program
• Vision insurance

Experience:

• insurance or hospital utilization review: 2 years (Required)

License/Certification:

• & unencumbered PA Registered Nurse license (Required)

Work Location: Remote