Job ID: 903916
Job TitleRegistered Nurse - Case Management
LocationPhiladelphia, PA | Acute Care
Schedule / Job TypeContract | Full-Time | Days | 8-Hour Shifts (8:00 AM - 4:30 PM) | Onsite
Key Responsibilities- Provide hospital-based case management services supporting adult and geriatric patient populations with an average daily census of approximately 25 patients
- Perform admission criteria review, concurrent review, continued stay review, medical necessity determinations, and retrospective review
- Coordinate care, discharge planning, and utilization review activities to facilitate appropriate patient transitions
- Manage appeals and denials processes in alignment with payer and regulatory requirements
- Apply InterQual Criteria and Milliman Guidelines to support clinical decision-making and documentation
- Float within scope to support hospital needs as required; availability to work one holiday is required
Required Qualifications- Active Pennsylvania RN License required at time of submission
- BSN required
- BLS certification required
- Minimum of 3 years of Case Management experience required
- Acute hospital experience required
- Experience in LTAC, Rehab, or Skilled Nursing settings required
- Med-Surg and SDU/PCU/IMC/Observation experience required
- Experience with admission criteria review, care coordination, discharge planning, utilization review, concurrent review, appeals, and denials required
- Proficiency with InterQual Criteria and Milliman Guidelines required
- Experience with Epic EMR required
- PA Fingerprints required; must be completed within one week of contract signing
- Candidates must live within 50 miles of the facility; local candidates are welcome and a local rate differential applies
Preferred Experience / Skills- Experience supporting case management department operations, growth, and development
- Familiarity with geriatric patient populations in an acute hospital setting
- CCM (Certified Case Manager) or related certification
Why Join Us- Opportunity to work in a dynamic, high-acuity urban hospital environment supporting a well-established Case Management department
- First-time travelers are welcome, making this an excellent opportunity for RNs looking to begin their travel career in case management