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Remote Rn Field Case Manager Jobs in Pennsylvania

Harris

$10/hr

Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no ... A minimum of two (2) years of clinical experience in a clinic setting, Med/Surg, Case Management ...

Harris

$10/hr

Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no ... A minimum of two (2) years of clinical experience in a clinic setting, Med/Surg, Case Management ...

Harris

$10/hr

Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no ... A minimum of two (2) years of clinical experience in a clinic setting, Med/Surg, Case Management ...

MCKESSON

Field Reimbursement Manager

Erie, PA · On-site +1

... remote interaction and on-site training. This position is client-facing and customer-facing and ... Reimbursement Support on Case management, billing and coding updates, appropriate claims submission ...

MCKESSON

Field Reimbursement Manager

York, PA · On-site +1

... remote interaction and on-site training. This position is client-facing and customer-facing and ... Reimbursement Support on Case management, billing and coding updates, appropriate claims submission ...

MCKESSON

Field Reimbursement Manager

Pittsburgh, PA · On-site +1

... remote interaction and on-site training. This position is client-facing and customer-facing and ... Reimbursement Support on Case management, billing and coding updates, appropriate claims submission ...

MCKESSON

Field Reimbursement Manager

Bethlehem, PA · On-site +1

... remote interaction and on-site training. This position is client-facing and customer-facing and ... Reimbursement Support on Case management, billing and coding updates, appropriate claims submission ...

MCKESSON

Field Reimbursement Manager

Philadelphia, PA · On-site +1

... remote interaction and on-site training. This position is client-facing and customer-facing and ... Reimbursement Support on Case management, billing and coding updates, appropriate claims submission ...

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All JobsRn Field Case JobsRemote Rn Field Case Manager JobsRemote Rn Field Case Manager Jobs in Pennsylvania

Remote Rn Field Case Manager information

What is the difference between Remote Rn Field Case Manager vs Remote Rn Utilization Review Nurse?

AspectRemote Rn Field Case ManagerRemote Rn Utilization Review Nurse
CertificationsRN license, case management certification often preferredRN license, certification in utilization review or case management beneficial
Work EnvironmentField-based, visiting patients and providers remotelyOffice-based, reviewing cases and medical records remotely
Employer & Industry UsageInsurance companies, workers' comp, healthcare providersInsurance companies, managed care organizations, healthcare payers
Common Search & ComparisonRemote Rn Field Case Manager vs Remote Rn Utilization Review Nurse

The Remote Rn Field Case Manager primarily conducts patient visits and manages cases in the field, while the Remote Rn Utilization Review Nurse focuses on reviewing medical necessity and appropriateness of care remotely. Both roles require RN licensure and related certifications, but differ in work environment and daily responsibilities.

What are popular job titles related to Remote Rn Field Case Manager jobs in Pennsylvania? For Remote Rn Field Case Manager jobs in Pennsylvania, the most frequently searched job titles are:
What job categories do people searching Remote Rn Field Case Manager jobs in Pennsylvania look for? The top searched job categories for Remote Rn Field Case Manager jobs in Pennsylvania are:
What cities in Pennsylvania are hiring for Remote Rn Field Case Manager jobs? Cities in Pennsylvania with the most Remote Rn Field Case Manager job openings:
Remote Rn Field Case Manager jobs near you

Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Long Term Living Expert)

The CKHobbie Group

Harrisburg, PA • On-site, Remote

$40 - $42/hr

Full-time

PTO

Re-posted 4 days ago

Job description


Are you a registered nurse ready to take your career in an exciting newdirection-one where your expertise truly makes a difference? JoinPennsylvania's premier Quality Improvement Organization and step into adynamic role focused on advocacy and program integrity through compliance management. Here, you'll champion the needs of vulnerable populations,safeguard the quality of care, and influence healthcare outcomes on ameaningful scale. Enjoy the freedom of working from home, theflexibility and autonomy to manage your workday, and the opportunity forcontinuous professional growth-all while being part of a passionate,mission-driven team dedicated to improving healthcare across theCommonwealth.
Are you a registered nurse ready to take your career in an excitingnew direction-one where your expertise creates real, lasting impact?Join Pennsylvania's premier Quality Improvement Organization and play a vital role in protecting healthcare quality, advocating forvulnerable populations, and ensuring the integrity of criticalhealthcare programs.
In this rewarding role, you'll use your clinical knowledge outside ofthe traditional bedside setting to review and audit claims, supportprogram integrity initiatives, and advocate for beneficiaries across theCommonwealth. You'll enjoy the flexibility of working from home, theautonomy to manage your work, and meaningful opportunities forprofessional growth-all while contributing to a mission that trulymatters.
What You'll Do
  • Conduct clinical reviews and ensure quality, appropriateness, and compliance with healthcare standards
  • Support program integrity efforts by identifying trends, risks, and opportunities for improvement
  • Advocate for beneficiaries, with a strong focus on protecting and improving care for vulnerable populations
  • Apply nursing judgment to analyze medical records, documentation, and billing data
  • Collaborate with interdisciplinary teams, providers, and stakeholders to promote best practices
  • Contribute to quality improvement initiatives that strengthen healthcare delivery across Pennsylvania

What We're Looking For
  • Active, unrestricted Registered Nurse (RN) license
  • Strong clinical background with the ability to apply nursing judgment analytically
  • Interest in advocacy, quality improvement, and healthcare program integrity
  • Excellent written and verbal communication skills
  • Ability to work independently while managing multiple priorities
  • Comfort with technology and electronic medical records

Experience in utilization review, case management, quality improvement, compliance, or claims review is a plus-but not required.
Why Join Us
  • Mission-driven work with Pennsylvania's leading Quality Improvement Organization
  • Make a real impact on healthcare quality and outcomes for vulnerable populations
  • Remote work - enjoy the convenience and balance of working from home
  • Autonomy and flexibility in how you manage your workday
  • Advocacy-focused role that values your nursing voice and expertise
  • Career development opportunities to grow beyond traditional nursing roles
  • Supportive, collaborative team culture committed to excellence and integrity

If you're a registered nurse seeking purpose-driven work,professional growth, and the flexibility to balance your life andcareer-this is your opportunity. Apply today and help shape the future of healthcare quality in Pennsylvania.
Requirements
Be available as a full-time consultant, approximately 37.5 hours per week;
• Possess a current license to practice as a Registered Nurse issued by the Pennsylvania
State Board of Nursing; or possess a non-renewable temporary practice permit issued
by the Pennsylvania State Board of Nursing. Resources possessing non-renewable
temporary practice permits must obtain licensing as a Registered Nurse within the
one-year period as defined by the Pennsylvania State Board of Nursing;
• Possess a documented work history of three (3) or more years of professional
experience with medical assistance, health care services or human services or any
equivalent combination of experience and training;
• Possess basic computer skills, including familiarity with Microsoft Office programs.
  • Evaluate and review medical, physical, rehabilitative, restorative, and other care being provided to determine appropriateness.
  • Review, understand and relate pertinent Departmental, State and Federal policies, licensing requirements, and regulations to ensure compliance by Medical Assistance (MA)/OLTL providers.
  • Participate in the development of new and/or revision to existing medical assistance policies and regulations.
  • Coordinate and interact with other Agencies and Departments to ensure appropriate services for individuals using long term living services.
  • Perform monitoring reviews in all Long-Term Living settings to determine that the provision and adequacy of medical, social, physical, rehabilitative, and restorative care services are being provided in accordance to all regulations and licensing criteria.
  • Review Minimum Data Set (MDS) submitted to the MDS database for accuracy and documentation support in the clinical records.
  • Review PA Pre-Admission Screening Resident Review (PA-PASRR-ID) process to assure nursing facilities (NF) compliance with the Omnibus Budget Reconciliation Act (OBRA).
  • Perform evaluations of identified targeted individuals residing in long term care facilities including submission of packet with recommendations to the appropriate Program Office (OMHSAS, ODP, ORC, or DMVA) for review.
  • Monitor appropriateness of NF admissions and determine need for continued stay by reviewing clinical records, evaluate discharge plans and interview staff and residents.
  • Perform financial reviews to identify recoveries to ensure adjustments are made for any inappropriate payments or billings in accordance with established regulations and guidelines.

Benefits
Attractive Compensation plan.Holiday and Vacation program.

Apply