What are the responsibilities and job description for the Utilization Management RN position at IntePros?
Job Title: Utilization Management RN
Department: Care Management and Coordination
Location: Remote – Candidates must reside in the tri-state area (PA/NJ/DE) to be eligible for potential conversion
Overview
We are currently seeking a Registered Nurse (RN) Utilization Management Coordinator to join our Care Management and Coordination team. This is a remote opportunity, but candidates must reside within the tri-state area to be considered for a full-time conversion opportunity.
The ideal candidate will bring strong post-acute experience and hold an active RN license in Pennsylvania (PA).
In this role, you will be responsible for conducting telephonic and/or onsite reviews of hospital admissions, collaborating with hospital staff, physicians, and families to ensure patients receive timely and appropriate care in the most suitable setting. Your work will contribute directly to the quality, efficiency, and cost-effectiveness of healthcare delivery for our members.
Key Responsibilities
Department: Care Management and Coordination
Location: Remote – Candidates must reside in the tri-state area (PA/NJ/DE) to be eligible for potential conversion
Overview
We are currently seeking a Registered Nurse (RN) Utilization Management Coordinator to join our Care Management and Coordination team. This is a remote opportunity, but candidates must reside within the tri-state area to be considered for a full-time conversion opportunity.
The ideal candidate will bring strong post-acute experience and hold an active RN license in Pennsylvania (PA).
In this role, you will be responsible for conducting telephonic and/or onsite reviews of hospital admissions, collaborating with hospital staff, physicians, and families to ensure patients receive timely and appropriate care in the most suitable setting. Your work will contribute directly to the quality, efficiency, and cost-effectiveness of healthcare delivery for our members.
Key Responsibilities
- Perform utilization management for inpatient admissions (onsite or telephonic).
- Apply established medical criteria to assess the need for inpatient care, continued stay, and appropriate length of stay.
- Collaborate with attending physicians to review and clarify treatment plans and medical necessity.
- Refer admissions not meeting criteria to plan Medical Directors and present relevant case information.
- Initiate early discharge planning and coordinate with hospital case management, physicians, and families.
- Identify members appropriate for case management and disease management programs.
- Escalate any quality-of-care concerns to the Quality Management Department.
- Maintain accurate, timely documentation and system data entry.
- Ensure all utilization decisions comply with state, federal, and accreditation regulations.
- Build strong relationships with providers and deliver exceptional customer service.
- Report potential utilization trends and suggest process improvements.
- Participate in provider education related to managed care processes.
- Perform other related duties as assigned.
- Active PA RN license required.
- Minimum of 3 years of acute care clinical experience in a hospital or healthcare setting.
- Prior experience in discharge planning and/or utilization management is highly desirable.
- Excellent communication skills at all levels—verbal and written.
- Strong clinical judgment and problem-solving abilities.
- Ability to multi-task, stay organized, and manage time efficiently.
- A proven team player with demonstrated ability to collaborate across departments.
- Proficient in using healthcare information systems and medical review criteria software.
