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RN Care Manager – Utilization Management at Loyola Medicine - ApplyBlast

RN Care Manager – Utilization Management

Loyola Medicine

22 days ago

3.1 on Glassdoor

Darby, Pennsylvania, United States

Onsite

Part Time

Medior

0 applicants

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About this role

Mercy Fitzgerald is seeking a dedicated RN Care Manager to join the Care Coordination team, focusing on ensuring appropriate utilization of resources and reimbursement. This role supports effective patient care by confirming medical necessity for admission and continued stay through collaboration with the healthcare team. The position involves performing clinically based utilization reviews and monitoring patient outcomes to support high-quality, cost-effective care.

Responsibilities

Perform clinically based utilization reviews to support efficient patient care delivery
Apply InterQual criteria to confirm medical necessity for inpatient admission and continued stay
Collaborate with physicians and healthcare professionals to ensure appropriate resource use and reimbursement

Skills

Qualifications

Bachelors of Science in Nursing (BSN)Active Registered Nurse license in the State of PennsylvaniaCase Management certification

About Loyola Medicine

loyolamedicine.org

Headquarters

Maywood, Illinois, United States

Company Size

5001-10000 employees

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Loyola Medicine is a not-for-profit health system providing comprehensive medical care across its hospitals and outpatient facilities in Illinois, including Loyola University Medical Center, Gottlieb Memorial Hospital, and MacNeal Hospital. The organization offers urgent and specialty care, telehealth visits, online scheduling, patient portal access (MyChart), and streamlined access to medical records and billing.