Experienced Care Management Coordinator RN - Utilization Management for Remote Healthcare Delivery

Join Our Team: Revolutionizing Healthcare through Innovation and Compassion At Independence Blue Cross (IBX), we're on a mission to lead nationally in innovating equitable whole-person health. We're seeking dynamic and compassionate Registered Nurses to join our team as Care Management Coordinators, playing a crucial role in our Utilization Management (UM) department. If you're a motivated professional who thrives on innovation and is dedicated to delivering exceptional patient care, we invite you to explore this exciting opportunity. About Our Organization IBX is a leading health insurance organization committed to improving the health and well-being of our members. We're passionate about fostering a culture of innovation, inclusivity, and collaboration. Our team is dedicated to providing high-quality, cost-effective healthcare solutions that meet the evolving needs of our members. Job Summary As a Care Management Coordinator RN, you will be responsible for overseeing and coordinating medical care provided to our members, ensuring that they receive appropriate and cost-effective treatment. You will act as a patient advocate, working closely with healthcare providers, families, and other stakeholders to facilitate high-quality care and optimal outcomes. Key Responsibilities Evaluate proposed plans of treatment against precertification requirements and medical criteria (InterQual and/or Medical Policy) Establish the need for inpatient care, continued stay, and ancillary services, directing care to the most appropriate setting Collaborate with attending physicians, facility case management staff, and family members to determine alternative care settings and facilitate discharge planning Identify quality of care issues, referring cases to the Quality Management Department and/or Clinical Services Supervisor as needed Maintain accurate and timely data entry, ensuring compliance with state, federal, and accreditation regulations Provide exceptional customer service, building relationships with healthcare providers and internal stakeholders Participate in educating providers on managed care principles and practices Stay adaptable and open to new ideas, creating and acting on opportunities for process improvement Qualifications and Requirements To be successful in this role, you will need: An active PA Registered Nurse license (BSN preferred) A minimum of three years of clinical experience (Intensive Care, Trauma, Home Health experience a plus) Medical management/precertification experience preferred Strong problem-solving and critical thinking abilities Proficiency in Microsoft Office applications (Word, Outlook, Excel, Access, SharePoint) and Adobe programs Excellent organizational and prioritization skills, with the ability to work independently Highly professional interpersonal skills, with the ability to navigate complex medical and interpersonal challenges What We Offer As a fully remote role, you will enjoy the flexibility and autonomy to work from anywhere within the Tri-State Area (Delaware, New Jersey, or Pennsylvania). Our organization is committed to providing a supportive and inclusive work environment that fosters professional growth and development. While specific compensation and benefits details are not provided, we offer a comprehensive package that includes: Competitive salary and benefits Opportunities for career advancement and professional growth A dynamic and supportive work environment Recognition and rewards for outstanding performance Why Join Our Team? At IBX, we're passionate about making a meaningful difference in the lives of our members. As a Care Management Coordinator RN, you will play a critical role in shaping the healthcare experience for our members, working closely with a talented team of professionals who share your commitment to excellence. We're an Equal Opportunity Employer, dedicated to fostering a culture of inclusivity and respect. We welcome applications from diverse candidates and are committed to providing equal consideration for employment without regard to age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Ready to Apply? If you're a compassionate and innovative Registered Nurse looking for a challenging and rewarding opportunity, we encourage you to apply for this exciting role. Please ensure you have a compatible Android or iOS device with the Microsoft Authenticator app installed. Join our team and help us revolutionize healthcare through innovation and compassion. Apply now to become a part of our dynamic team! Schedule: Tuesday - Saturday, 8:30-5p (no no-call) Location: Fully remote within the Tri-State Area (Delaware, New Jersey, or Pennsylvania) Apply for this job