Pennsylvania Licensed Case Manager

To ensure appropriate use of hospital resources, the full-time Pennsylvania Licensed Case Manager will conduct clinical reviews, evaluate admission appropriateness, and educate on patient class assignments in a remote setting. Key responsibilities Conduct timely and accurate clinical reviews to assist in patient class decision-making Develop and implement policies and procedures to enhance departmental efficiency Collaborate with care managers and other departments to facilitate appropriate patient class assignments and maximize reimbursement Required qualifications Specialized Diploma in nursing 2 years of previous utilization review experience Knowledge of utilization management as it relates to third-party payers RN - Licensed Registered Nurse in Pennsylvania upon hire Ability to maintain strict adherence to HIPAA and confidentiality of PHI