Part Time Care Management Coordinator (RN) – Utilization Management

IntePros is an established, woman-owned, privately-held technology and business services consulting agency committed to building long-term relationships and helping more companies leverage the power of a more diverse workforce.

Care Management Coordinator (RN) – Utilization Management Location: Remote (PA, DE, NJ only) Schedule: Part-Time (2 weekdays + every other weekend, 9:00 AM – 5:00 PM) We are seeking an experienced Registered Nurse (RN) with a strong background in Utilization Management to join a dynamic care management team. This role is ideal for a clinically strong, detail-oriented professional who thrives in a fast-paced, decision-driven environment and is passionate about ensuring patients receive appropriate, high-quality care. The Care Management Coordinator plays a critical role in evaluating medical necessity, supporting care coordination, and ensuring compliance with regulatory standards—while serving as both a clinical resource and patient advocate. Position Overview In this role, you will independently review medical records and apply established clinical criteria to determine the appropriateness of services. You will collaborate closely with providers, case management teams, and leadership to support care decisions, facilitate appropriate treatment plans, and ensure optimal patient outcomes. This position has the authority to approve medically necessary services and escalate cases that do not meet criteria to the Medical Director for further review.

Conduct comprehensive reviews of medical records to determine medical necessity, level of care, and length of stay Apply clinical guidelines such as InterQual and Medical Policy to support decision-making Collaborate with providers to clarify clinical information and treatment plans Identify cases that do not meet criteria and escalate to the Medical Director for review Support discharge planning and care coordination, ensuring appropriate level of care and transitions Ensure all determinations align with federal, state, and accreditation standards Maintain accurate, timely documentation and data entry within care management systems Monitor and report utilization trends and opportunities for process improvement Partner with internal teams to address delays in care and improve patient outcomes Serve as a resource and advocate for members navigating the healthcare system