Job description
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.
Responsibilities
- 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
Requirements
- Qualifications: Active Registered Nurse (RN) license in Pennsylvania or Nurse Licensure Compact (NLC) including PA
BSN preferred
Minimum 3+ years of Medical/Surgical nursing experience
Prior experience in Utilization Management within an acute care setting
Strong working knowledge of InterQual (IQ) criteria
Skills & Expertise: Strong clinical judgment and critical thinking skills
Excellent communication and provider engagement abilities
Proven ability to work independently and make sound clinical decisions
Highly organized with strong time management and prioritization skills
Comfortable working with clinical systems and Microsoft Office tools
Adaptable, collaborative, and solutions-oriented mindset
What Success Looks Like: Consistently makes accurate, timely utilization decisions
Effectively collaborates with providers and internal teams to optimize care outcomes
Maintains regulatory compliance and documentation integrity
Identifies opportunities to improve efficiency, care quality, and member experience
This is an excellent opportunity for a Utilization Management RN seeking a flexible, part-time schedule while continuing to make a meaningful impact on patient care and healthcare delivery.
About IntePros
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.
