RN Care Coordinator - RN in Pennsylvania (Westmorland, Washington, Fayette, Green or Somerset Counties)

Location: Hybrid work from home in Pennsylvania, with travel within Westmorland, Washington, Fayette, Green, or Somerset Counties. Travel requirement: 50%–75%.

Company

hirify.global provides health and care management services supporting patients, providers, and health plans.

What you will do

• Assess patients’ physical, psychosocial, and economic needs and develop transition-of-care plans.
• Coordinate care plans with physicians, care teams, health service providers, and outpatient providers.
• Document patient data, review charts, monitor interventions and outcomes, and evaluate readmission-related information.
• Obtain and manage pre-certification, urgent, continued-stay, and post-acute service authorizations.
• Monitor and resolve clinical denials, appeals, and retrospective payer audit denials.
• Provide education on utilization review practices, payer guidelines, regulatory requirements, and care management changes.

Requirements

• Bachelor’s degree in Nursing, or six years of related and 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 current multistate licensure through the enhanced Nurse Licensure Compact (eNLC).
• Competence in motivational interviewing and advance care planning.
• Strong organizational, time-management, communication, teamwork, and computer skills, including Microsoft Office.
• CPR certification.

Nice to have

• Experience in home care, hospice, or palliative care.
• Knowledge of discharge planning and community resources.
• Experience with care facilitation and utilization review.

Culture & Benefits

• Hybrid work-from-home arrangement with regular travel to work sites and members.
• Collaboration with care coordination, performance improvement, physician advisor, and payer teams.
• Ongoing professional development and required continuing education.
• Work involving patient information is governed by HIPAA, privacy, information security, and regulatory compliance requirements.