RN Care Coordinator - RN (Healthcare)

Location: Remote/hybrid work from Pennsylvania with 50%–75% travel within Westmorland, Washington, Fayette, Green, or Somerset Counties. The role requires direct work with members at their locations and a physical work site.

Company

hirify.global provides healthcare and health insurance services with a focus on coordinated patient care and resource utilization.

What you will do

• Assess patients’ physical, psychosocial, and economic needs and plan transitions across levels of care.
• Coordinate care plans with clinical teams and communicate them to appropriate health service providers.
• Collect, verify, and document patient and clinical data, including information related to readmissions.
• Obtain pre-certification, urgent, continued-stay, and post-acute service authorizations using medical-necessity criteria.
• Monitor and resolve clinical denials, appeals, and retrospective payer audits.
• Provide guidance on utilization review, payer requirements, regulatory standards, and care management practices.

Requirements

• Bachelor’s degree in Nursing, or six years of related progressive experience in lieu of the degree.
• At least two years of recent clinical RN experience in acute care, home care, palliative care, hospice, or care management.
• Current Pennsylvania RN licensure or multistate licensure through the enhanced Nurse Licensure Compact (eNLC) required.
• Strong knowledge of discharge planning, community resources, care facilitation, and utilization review.
• Motivational interviewing and advance care planning competencies.
• Organizational, time-management, teamwork, computer, and Microsoft Office skills; CPR certification is preferred.

Culture & Benefits

• Full-time hybrid work-from-home arrangement.
• Regular travel from the office or home to assigned work sites and member locations.
• Collaboration with care teams, physicians, performance improvement teams, providers, and third-party payers.
• Ongoing professional education and development.
• Work governed by healthcare accreditation, HIPAA, privacy, security, and applicable federal and state requirements.