Post Acute Utilization Manager (RN)

Job Type: Contract

Assignment Dates: September 14, 2026 - December 12, 2026
Potential for Extension/Conversion: Yes, assignment extension or permanent conversion possible

Location: Remote
Residency Requirement: Candidates must reside in Pennsylvania (PA), New Jersey (NJ), or Delaware (DE)

Pay Rate: Up to $44/hour

Required Qualifications

• Active Pennsylvania RN License or Compact RN License required
• Minimum of 3 years of acute care clinical experience in a hospital or healthcare setting
• Post Acute experience required
• Prior discharge planning and/or utilization management experience preferred
• Strong communication skills
• Excellent problem-solving abilities
• Strong organizational and team collaboration skills
• Team-oriented mindset

Job Summary

Under the direction of the Care Management and Coordination Supervisor, the Post Acute Utilization Manager performs telephonic and/or onsite utilization review of hospital admissions. This role focuses on ensuring the appropriate level of care, promoting efficient use of healthcare resources, facilitating timely discharge planning, and supporting quality patient outcomes. The Utilization Manager collaborates closely with physicians, hospital staff, members, and families to coordinate care and identify appropriate post-acute settings when applicable.

Key Responsibilities

• Perform utilization management reviews for inpatient admissions via telephone or onsite.
• Apply medical necessity criteria to determine inpatient admission status, continued stay requirements, and appropriate length of stay.
• Ensure members receive care in the most appropriate and cost-effective setting while maintaining quality outcomes.
• Communicate with attending physicians regarding treatment plans, medical necessity, and continued inpatient care needs.
• Identify admissions that no longer meet criteria and refer cases to Medical Directors for evaluation.
• Present cases to Medical Directors, providing relevant clinical information and anticipated care needs.
• Conduct early assessments to identify discharge planning needs.
• Collaborate with hospital case management teams, physicians, and families to facilitate discharge to appropriate care settings.
• Identify and refer members for case management and disease management programs when appropriate.
• Recognize potential quality-of-care concerns and escalate cases to Quality Management and leadership as needed.
• Maintain accurate and timely documentation within utilization management systems.
• Ensure utilization decisions comply with state, federal, and accreditation requirements.
• Build and maintain positive relationships with providers while delivering exceptional customer service.
• Report utilization trends, issues, and process improvement recommendations to leadership.
• Participate in provider education regarding managed care processes.
• Perform additional duties as assigned.

Preferred Experience

• Utilization Management
• Care Management
• Discharge Planning
• Managed Care
• Post-Acute Care Coordination
• Inpatient Utilization Review

Must-Have Requirements

✅ Post Acute experience
✅ Active PA or Compact RN License
✅ 3+ years of acute care clinical experience
✅ Resident of PA, NJ, or DE

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