Utilization Management RN

Care Management Coordinator (Precertification Team – PT / OT / ST & Bariatric Reviews)

Remote – Must Reside in the Tri-State Area (PA, NJ, or DE)

IntePros is seeking an experienced and detail-oriented Care Management Coordinator to join our Precertification Team, specializing in Physical Therapy, Occupational Therapy, Speech Therapy, and Bariatric procedure reviews. This position is ideal for a nurse with a strong background in orthopedics, general outpatient ambulatory surgery, or surgical units, who thrives in a collaborative and fast-paced remote environment.

Key Responsibilities

Evaluate member clinical conditions through detailed medical record reviews to determine medical necessity for requested services.

Apply advanced clinical judgment using InterQual, Care Management Policies, Medical Policies, and other resources to make utilization determinations.

Contact servicing providers to clarify treatment plans and obtain additional medical information as needed.

Review treatment plans and proposed procedures for medical appropriateness and ensure they align with benefit coverage and policy criteria.

Refer cases not meeting established criteria to the Medical Director for further evaluation.

Identify discharge planning needs early and collaborate with case management or physicians to ensure timely and appropriate transitions of care.

Monitor and report utilization trends or potential quality issues, recommending process improvements where applicable.

Maintain compliance with state, federal, and accreditation standards for utilization review and documentation.

Meet or exceed turnaround and productivity goals for authorization requests.

Accurately document all activities in accordance with Care Management and Coordination policies.

Qualifications

Education & Licensure

Active RN license in Pennsylvania required (multi-state compact licensure preferred).

BSN strongly preferred.

Experience

Minimum 3 years of acute care clinical experience in a hospital or other healthcare setting.

Experience in discharge planning, utilization management, or precertification preferred.

Background in orthopedic, outpatient surgical, or ambulatory care strongly desired.

Skills & Competencies

Excellent critical thinking, problem-solving, and communication skills.

Strong organizational and time management abilities with attention to detail.

Proficiency with Microsoft Word, Excel, Outlook, SharePoint, and Adobe; ability to learn new systems quickly.

Ability to work effectively in a team-oriented, remote environment.

Adaptable, resourceful, and comfortable with change and evolving technology.

Committed to diversity, equity, and inclusion, and respectful collaboration with colleagues across all levels.

Why Join Us?

This is a great opportunity to leverage your clinical expertise in a non-bedside, remote role while continuing to make a meaningful impact on patient care. You’ll work alongside a supportive team that values collaboration, innovation, and professional growth.