Care Management Coordinator/RN
Company: Pyramid Consulting, Inc
Location: Philadelphia
Posted on: February 28, 2026
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Job Description:
Job Description Immediate need for a talented Care Management
Coordinator/RN. This is a 03 months contract opportunity with
long-term potential and is located in Within PA,NJ and DE(Remote) .
Please review the job description below and contact me ASAP if you
are interested. Job Diva ID: 26-06081 Pay Range: $40 - $45 /hour.
Employee benefits include, but are not limited to, health insurance
(medical, dental, vision), 401(k) plan, and paid sick leave
(depending on work location). Key Responsibilities: - Applies
critical thinking and judgement skills based on advanced medical
knowledge to cases utilizing specified resources and guidelines to
make case determination. Utilizes resources such as InterQual, Care
Management Policy, Medical Policy and Electronic Desk References to
determine the medical appropriateness of the proposed plan.
Utilizes the medical criteria of InterQual and/or Medical Policy to
establish the need for inpatient, continued stay and length of
stay, procedures and ancillary services. Contacts servicing
providers regarding treatment plans/plan of care and clarifies
medical need for services. Reviews treatment plans/plan of care
with provider for requested services/procedures, inpatient
admissions or continued stay, clarifying medical information with
provider if needed. Identifies and refers cases in which the plan
of care/services are not meeting established criteria to the
Medical Director for further evaluation determination. Performs
early identification of members to evaluate discharge planning
needs. Collaborates with case management staff or physicians to
determine alternative setting at times and provide support to
facilitate discharge to the most appropriate setting. Reports
potential utilization issues or trends to designated manager and
recommendations for improvement. Appropriately refers cases to the
Quality Management Department and/or Care Management and
Coordination Manager when indicated to include delays in care.
Appropriately refers cases to Case and Disease Management. Ensures
request is covered within the member’s benefit plan. Ensures
utilization decisions are compliant with state, federal and
accreditation regulations. Meets or exceeds regulatory turnaround
time and departmental productivity goals when processing
referral/authorization requests. Ensures that all key functions are
documented via Care Management and Coordination Policy. Maintains
the integrity of the system information by timely, accurate data
entry. Performs additional duties assigned. Key Requirements and
Technology Experience: PA RN license (only) required! Position is
remote - candidate must reside in the tri-state area (PA, DE, NJ)
Would work on Infusion Therapy Team Previous Utilization
management/ IQ experience Our client is a leading Health Insurance
Industry, and we are currently interviewing to fill this and other
similar contract positions. If you are interested in this position,
please apply online for immediate consideration Pyramid Consulting,
Inc. provides equal employment opportunities to all employees and
applicants for employment and prohibits discrimination and
harassment of any type without regard to race, color, religion,
age, sex, national origin, disability status, genetics, protected
veteran status, sexual orientation, gender identity or expression,
or any other characteristic protected by federal, state, or local
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Keywords: Pyramid Consulting, Inc, Hackensack , Care Management Coordinator/RN, Healthcare , Philadelphia, New Jersey
