RN Care Management Coordinator #36314

This a Full Remote job, the offer is available from: United States Contemporary Staffing Solutions is seeking an RN Care Management Coordinator to join our client for a remote opportunity (must be located in Pennsylvania, Delaware, or New Jersey). The RN Care Management Coordinator plays a vital role in assessing and coordinating the behavioral health (BH) care needs of members. Through comprehensive evaluation of medical records and direct interaction with providers, the Coordinator determines the medical necessity for patient services, adhering to established criteria and guidelines. This contract opportunity offers $33.75-$37.50/Hour! Key Responsibilities: - Evaluate members' behavioral health condition through advanced medical record review and independent analysis. - Utilize resources such as InterQual, ASAM criteria, and Medical Policy to determine medical appropriateness. - Collaborate with providers to clarify treatment plans and medical necessity for services. - Identify cases not meeting established criteria and refer to the Medical Director for further evaluation. - Conduct early identification of members for discharge planning needs and facilitate appropriate transitions of care. - Report utilization issues or trends to designated managers and recommend improvements. - Ensure compliance with state, federal, and accreditation regulations. - Document all key functions in accordance with Care Management Coordination Policy. - Maintain system integrity through accurate data entry and adherence to turnaround time goals. - Perform additional duties as assigned. Qualifications: - LCSW, LMFT, LPC, or Active PA Licensed RN; BSN Preferred - Minimum of three (3) years of Behavioral Health clinical experience in a healthcare setting. - Prior Behavioral Health utilization management experience preferred. - Medical management/precertification experience is desirable. - Excellent communication, problem-solving, and interpersonal skills. - Ability to prioritize tasks and achieve results in a remote environment. - Strong team player with the ability to build rapport across departments. - Flexible and adaptable to change, embracing diversity in the workforce. - Proficient in Microsoft Office suite and ability to learn new systems. - Knowledgeable in current trends of medical practice. Contemporary Staffing Solutions (CSS) has been a leading provider of contract, temporary, temporary-hire & direct hire solutions. We began as a staffing agency and evolved to a national provider of workforce management solutions with a niche recruitment focus in Accounting & Finance, Call Center & Office, Human Resources, Sales & Marketing, & Information Technology. To learn more about CSS, visit our website: www.ContemporaryStaffing.com. This offer from "Contemporary Staffing Solutions" has been enriched by Jobgether.com and got a 72% flex score. Apply Job!