(610) 832-2001

 

Open Positions



We offer: Competitive pay, generous benefits, including 401K, medical and dental benefits, LTD, PTO, a flexible work schedule, partial telecommuting (after training period), and a friendly, business casual work environment.

ProgenyHealth is an Equal Opportunity Employer.


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Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558
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Case Manager – Pediatric Nurse

Job Description:

The Case Manager is a registered nurse managing the continuum of care for infants and their families. The Case Manager works in a telephonic managed care setting combining strong clinical knowledge and critical thinking to facilitate a care plan that will ensure quality medical care for the high-risk member population serviced by ProgenyHealth based on national standards for case management practice. The Case Manager will focus on empowering the family to support optimal wellness while advocating for necessary medical services.

Job Responsibilities:
  • Making introductory calls to families to provide them with an overview of our services
  • Completing needs assessments for all infants in case management and developing care plans individualized to the needs of each infant and their family
  • Stratifying infants based on their needs at the appropriate case management level and providing frequent outreach calls to manage ongoing needs
  • Interfacing with the infant’s PCP and other neonatal providers to assist with activities which can include coordinating appointments, transportation, medical equipment etc
  • Provides ongoing case management services to assist families after discharge as the primary contact to assist with care coordination needs throughout the first year of life
Job Requirements:
  • Registered Nurse (RN) with a current, unrestricted license is required
  • Three or more years of clinical experience in a pediatric environment
  • CCM preferred
  • Two or more years of managed care experience in a hospital, integrated health system or health plan in a case management and/or discharge planning role is preferred
  • Data entry skills required. Must be computer literate
  • Excellent communication skills and organizational ability is required. Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks
  • Must demonstrate accuracy in spelling and documentation
  • Ability to perform job functions with autonomy and be a self-starter
  • Demonstrated strength in working independently as well as collaboratively within a team environment
  • Must possess excellent interpersonal skills, telephone etiquette and maintain positive communication at all times
  • Must have commitment to excellence in customer service
Job Location:
  • Plymouth Meeting, PA


Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558

Concurrent Review Nurse

Job Description:

The Concurrent Review Nurse is a registered nurse managing the continuum of care from the moment an infant is admitted to a special care nursery/NICU. This process ensures that all resources are used efficiently and effectively from pre-admission, continued stay (concurrent review), discharge planning and post-hospitalization care. Concurrent Review Nurses coordinate overall member care, utilizing the principle of continuous quality improvement as stated in our company mission statement. The Concurrent Review Nurse serves as a hospital nurse reviewer for admissions, lengths of stay and a facilitator for discharge planning. She/he is responsible for the implementation of managed care policies and must be very knowledgeable about the criteria and guidelines used for reviews. Must be adept at identifying and referring potential quality of care issues.

Job Responsibilities:
  • Initiating the continuum of care process for neonatal admissions
  • Interacting telephonically with hospital staff to collect clinical information for newborns in intensive care nurseries in order to facilitate hospital reimbursement for services
  • Coordinating discharge planning needs for newborns being discharged home from intensive care nurseries
  • Documenting all activities in the electronic medical record
Job Requirements:
  • Registered Nurse (RN) with a current, unrestricted license is required
  • Three or more years of clinical experience required
  • NICU or Pediatric Intensive Care nurse preferred
  • Two or more years of managed care experience in a hospital, integrated health system or health plan in a concurrent review and discharge planning role is preferred
  • Data entry experience required. Must be computer literate
  • Excellent communication skills and organizational ability is required. Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks
  • Must demonstrate accuracy in spelling and documentation. Proficiency in a second language is highly desirable
  • Ability to perform job functions with autonomy and be a self-starter
  • Must possess excellent interpersonal skills, telephone etiquette and maintain positive communication at all times
  • Must have commitment to excellence in customer service
Job Location:
  • Plymouth Meeting, PA





Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558
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Director of Healthcare Sales

Job Description:

ProgenyHealth has an exciting opportunity for a Director focused in Healthcare Sales. You must be ready to make an impact, leverage relationships and produce significant revenue results. This Director must understand complex sales and be highly motivated and determined to identify, and close new business opportunities driving pipeline growth.

Job Responsibilities:
  • Expand our footprint through a variety of direct and indirect engagement strategies, including direct sales & working with client managers to showcase our broad range of products and services.
  • Will be responsible for conducting full life cycle sales activities from identifying, prospecting, qualifying, pricing, demonstrating value, negotiating and closing sales opportunities.
  • Develop and prepare responses to all prospect RFP’s.
  • Represent Progeny at industry events, trade shows, thought leadership activities, including presentations as needed.
  • Bachelor’s degree in health, business, or public service.
  • Master’s degree preferred.
  • Analyze sales activities. Identify and recommend strategies to improve sales performance and ensure Progeny is competitive in the market.
  • Provide regular sales reports, forecasts, and other related communications as requested.
Job Requirements:
  • A minimum of 10 years of experience conducting full life cycle sales activities from identifying, prospecting, qualifying, pricing, demonstrating value, negotiating and closing sales opportunities.
  • Comfortable and well versed in all aspects of selling, from lead generation and cold calling to handling sophisticated business development meetings with C-Suite level clients.
  • Exemplary interpersonal and relationship building skills, and professional presence to sell to clients at all levels.
  • Proven negotiation and closing skills in a challenging and competitive environment, managed care preferred.
  • Strong experience in developing sales strategies and performance metrics.
  • Strong understanding of networking via social media.
  • Strong ability to be collaborative and willingness to embrace new challenges in a growing and dynamic environment.
  • Ability to travel up to 60%.
Job Location:
  • Plymouth Meeting, PA

 

 





Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558
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RN – Case Manager – 100% Virtual

Job Description:

The Case Manager will focus on empowering the members’ family to support optimal wellness while advocating for the necessary medical services across the health care continuum. The Case Manager works in a telephonic managed care setting combining strong clinical knowledge and critical thinking to facilitate a plan of care that will ensure quality medical care for the high-risk member population serviced by ProgenyHealth Inc. based on the CMSA national standards for case management practice.

Job Responsibilities:
  • Utilizes the case management process of engaging, assessing, planning, implementing, monitoring, and, evaluating the needs of the high-risk neonatal population
  • Initiating engagement with member’s caregiver during inpatient stay in order to support the treatment plan and discharge planning process.• Acting as a member advocate by the appropriate selection of services, based upon member’s benefits, for appropriate utilization of resources, and providing an ongoing evaluation of member outcomes
  • Referring members’ caregivers to community resources when appropriate and based upon client specific requirements
  • Working in a telephonic managed care setting, combining strong clinical knowledge and critical thinking to facilitate a plan of care that will ensure quality medical care for the high-risk member population serviced by ProgenyHealth Inc.
  • Developing care plans individualized to the needs of each infant and his/her family
  • Participating in case management rounds with ProgenyHealth and client teams to discuss barriers and opportunities to improve health outcomes
  • Collaborating with other ProgenyHealth staff, families, facility staff, community agencies, primary care and specialist offices to ensure that evidence-based protocols are utilized in treatment plan
  • Utilizing motivational interview skills to maintain caregiver engagement through the first year of member’s life.
Job Requirements:
  • Registered Nurse (RN) with a current, unrestricted license is required – Must live in the State of MO.
  • Three or more years of clinical experience as a Pediatric/NICU nurse or Adult ICU* is required.
  • * If clinical experience is Adult ICU, candidate must have experience working in a health plan in a CM or discharge planning role.
  • NICU or Pediatric Intensive Care nurse preferred.
  • Five or more years of managed care experience in a health plan in a case management role is required.
  • Experience with Data entry into a database or EHR required. Must have strong computer skills.
  • Excellent communication skills and organizational ability is required. Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks
  • CCM certification highly desirable and is required after two years of employment
  • Ability to perform job functions with autonomy and be a self-starter
  • Must possess excellent interpersonal skills, telephone etiquette and maintain positive communication at all times
  • Must have commitment to excellence in customer service




Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558
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Concurrent Review Nurse/Utilization Review – 100% Virtual

Job Description:

Clinical care nurses coordinate overall member care, from pre-admission, continued stay (concurrent review) and any outpatient services utilizing a proactive, evidence-based decision-making process that is physician sensitive and attaining quality outcomes for the members. The clinical care nurse serves as a nurse reviewer for admissions, lengths of stay and a facilitator for discharge planning. This position functions as a liaison between the providers, hospitals, and health plans. Responsible for the implementation of client-specific contracted policies, managed care policies and must be very knowledgeable about benefits, criteria, and guidelines used for reviews. Must be adept at identifying and referring potential quality of care issues to the Medical Director, client and/or appropriate staff.

Job Responsibilities:
  • Initiating the continuum of care process for neonatal admissions.
  • Interacting telephonically and in writing with hospital staff to collect clinical information for newborns in intensive care nurseries in order to facilitate medical necessity determinations.
  • Coordinating discharge planning needs for newborns being discharged from intensive care nurseries.
  • Authorization of all services requiring prior authorization, based upon health plan specific service agreements
  • Review of all services (readmissions and elective procedures) for first year of life
  • Documenting all activities in the electronic medical record.
Job Requirements:
  • Must live in the state of MO
  • Registered Nurse (RN) with a current, unrestricted license is required
  • Three or more years of clinical experience as a Pediatric/NICU nurse or Adult ICU nurse is required.
  • Five or more years of managed care experience in a health plan in a discharge planning role is required.
  • Experience with InterQual and/MCG preferred.
  • Experience with URAC or NCQA standards preferred
  • Data entry skills required.
  • Must be comfortable with and have good computer skills.
  • Excellent communication skills and organizational ability is required.
  • Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks.
  • Must demonstrate accuracy in spelling and documentation. Ability to perform job functions with autonomy and be a self-starter. Must possess excellent interpersonal skills, telephone etiquette and maintain positive communication at all times.
  • Must have a commitment to excellence in customer service.




Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558
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Medical Director

Job Description:

The Medical Director will report to the CMO and will support the ProgenyHealth Medical Management program by conducting medical necessity review on impatient, outpatient, pharmaceutical, DME, new technology and home care requests as needed and to complete the cases in the required timeframes to be in compliance with URAC & NCQA standards.

Job Responsibilities:
  • Rounding with ProgenyHealth clinical care nurses and case managers to offer recommendations, support and clinical expertise to assist with concurrent review of cases for medical necessity based on criteria, guidelines and clinical judgment.
  • Conducting medical necessity reviews on inpatient, outpatient, pharmaceutical, DME, new technology and home care requests as needed.
  • Proactively call attending physicians as needed to discuss and clarify medical/surgical plans of care and any discharge planning needs or to make recommendations supporting evidence based best practices when variations in care are identified.
  • Responding to requests for a peer to peer conversation or other medical management discussion from/with an attending or ordering provider to discuss a case, determination, or other matter.
  • Identifying and address Quality of Care issues, participate in Quality Improvement programs
  • Ensuring fair and consistent decision making through the use of approved criteria and guidelines and provides guidance and is responsible for all clinical aspects of Medical Management.
  • Preparing and delivering clinical educational presentations to staff when requested.
  • Striving to exceed customer expectations and as such serve to support the desired image of excellence of service.
Job Requirements:
  • Registered Nurse (RN) with a current, unrestricted license is required
  • Three or more years of clinical experience in a pediatric environment
  • CCM preferred
  • Two or more years of managed care experience in a hospital, integrated health system or health plan in a case management and/or discharge planning role is preferred
  • Data entry skills required. Must be computer literate
  • Excellent communication skills and organizational ability is required. Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks
  • MD/DO degree and Board certified in a primary care specialty required
  • Minimum of three years clinical practice experience in Pediatric medicine after residency
  • A minimum of 1 year experience in a managed care environment or relevant hospital experience as a physician advisor or medical director preferred.
  • Must be organized, self-motivated and willing to learn multiple tasks.
  • Must have excellent computer skills and be proficient in Microsoft office
  • Active, unrestricted license to practice medicine
Job Location:
  • Plymouth Meeting, PA
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Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558
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Supervisor of Case Management or Utilization Review

Job Description:

The incumbent will primarily be responsible for managing the CM or UM nursing staff in the day to day operations of the department. This includes oversight and adjustment of work queue’s when needed to maintain work flow balance, monitoring and implementing adherence to department and company metrics, training of new hires and on-going clinical, and various other responsibilities to support the clinical nursing staff and the company program. The incumbent will also be responsible for assessment of the CM or UM program for opportunities to improve efficiencies and/or improve outcomes.

He/she will work closely with the management staff and will play a key role in implementing the culture and work environment that promotes and inspires an active, continuous improvement philosophy with regard to products and services in line with our company mission statement which is as follows:

To improve the health outcomes of infants in intensive care nurseries through partnership, care
facilitation, continuous quality improvement and a firm commitment to excellence.

Job Requirements:
  • Registered Nurse (RN) with a current, unrestricted license is required.
  • Two or more years of experience in Managed Care in a case management or utilization review role
  • Three or more years’ experience in a supervisory role managing nursing staff
  • CCM certification preferred. For CM Supervisor
  • Three or more years of clinical experience as a bedside nurse in NICU/PICU/Peds or other Intensive care unit preferred.
  • Must be available to stay late as needed to manage staff and caseloads
  • Experience with URAC standards preferred
  • Must have demonstrated strong problem solving skills
  • Must have proven track record of utilizing tact, diplomacy and strategic thinking in addressing issues and changes in company policy, etc.
  • Must be organized, self-motivated and willing to learn multiple tasks.
  • Must be well organized and able to prioritize tasks
  • Must have good computer skills and be familiar with using Microsoft Office (Word, Outlook etc)
  • Must demonstrate accuracy in spelling and documentation.
  • Must have commitment to excellence in customer service.
Job Location:
  • Plymouth Meeting, PA
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Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558
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Sr. Manager/Director of Utilization Management

Job Description:

The incumbent will primarily be responsible for setting team direction, resolving problems and providing guidance in the day to day operations of the department to members of own UM leadership team. This includes oversight of supervisors and managers to ensure that RN’s and administrative staff are meeting metrics, monitoring and implementing adherence to department and company policies, evaluating the training of new hires and on-going clinical updates and various other responsibilities to support the UM program. The incumbent will also be responsible for identifying, collecting and analyzing metrics in conjunction with established program targets to assess the effectiveness of the UM program and implement process changes to improve efficiencies and/or improve outcomes. This role is responsible for collaborating with client services to develops solutions to address new, often complex customer requirements that address operational, clinical and customer needs.

He/she will work closely with the management staff to create a work environment that supports change and models accountability for staff as well as play a key role in implementing the culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission statement which is as follows:

With passion and a singular focus, we improve the health outcomes of premature and medically complex newborns through provider collaboration and parental engagement.

Job Requirements:
  • Registered Nurse (RN) with a current, unrestricted license is required.
  • Three or more years’ experience in a manager role over nursing staff is required preferably in a managed care environment.
  • Five or more years of experience in Managed Care in a utilization management/concurrent review role.
  • Three or more years of clinical experience as a bedside nurse in NICU/PICU/Peds or other Intensive care unit preferred.
  • Must be available outside normal business hours to meet day to day and project deadlines.
  • Must be self-motivated and willing to learn new systems and software.
  • Experience with URAC standards preferred
  • Must have demonstrated strong problem solving skills
  • Must have proven track record of utilizing tact, diplomacy and strategic thinking in addressing issues and changes in company policy or strategic direction.
  • Must be organized, self-motivated and willing to learn multiple tasks.
  • Must be well organized and able to prioritize tasks
  • Must be adept at computer skills and be able to learn various clients’ medical management software systems.
  • Must demonstrate accuracy in spelling, documentation and data summaries.
  • Must be able to synthesize data to evaluate trends in department; both productivity as well as clinical.
  • Must have commitment to excellence in customer service.
Job Location:
  • Plymouth Meeting, PA
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Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558
[/cta] [/one_third]

Project Manager

Job Description:

ProgenyHealth is looking for a Project Manager to proactively lead and provide oversight of projects across the organization’s Clinical, Business and IT functions. This candidate will be responsible for managing multiple projects through various stages of the project lifecycle to supporting project definition, project planning, identification of timelines and key milestones, resource allocations, and process improvement initiatives. The project manager will support technical, business and client implementation projects. This role is positioned to ensure ProgenyHealth’s success in timely delivery of solutions to stakeholders as aligned with corporate goals and objectives. EOE.

Job Responsibilities:
  • Manage multiple projects for IT, Business or Client Implementations that range in various levels of difficulty as well as varying implementation/delivery timelines (a few weeks vs. 1+ year. Create and manage project plan to identify project tasks and milestones.
  • Identify and engage cross-functional stakeholders, including internal and external parties.
  • Manage all resource allocations, and task planning during the project including internal clinical, IT, business, vendors, contractors, and consultant resources.
  • Tracks progress and communicates project status on a regular basis to all impacted parties through all phases of the project lifecycle.
  • Ensure project milestones and related deliverables are completed and approved.
  • Ensure awareness and communication of project dependencies and critical path tasks across business functions.
  • Conduct project status meetings to establish and execute on detailed project plans;
  • Maintain thorough meeting minutes and action/issue item tracking.
  • Collaborate with business owners on the identification and assignment of business resources.
  • Builds communication plans for implementation to ensure all impacted parties are informed of next steps for completion.
  • Perform any other job related instructions as requested.
Qualifications:
  • 2 – 5 years of Project management experience is required.
  • Project Management Professional (PMP) or CAPM certification is preferred
  • Bachelor’s degree in Project Management, Business, Information Technology or related field or equivalent years of relevant experience is required
  • Proficient use of project management software (Microsoft Project), tools and supporting processes is required
  • Proficient with Microsoft Word, Excel, PowerPoint, Visio, SharePoint and related tools for managing detailed project related documentation.
  • Proven ability to effectively interact with all levels of stakeholders within the organization
  • Experience supporting clinical care management environments is ideal.
  • Understanding of best practices around software development lifecycle
  • Effectively communicates in a timely manner working across business functions (Clinical, IT, Client Services, etc.) and build effective relationships both internal and external to the organization.
  • Consistently organized with a keen eye for detail.
  • Excellent listening, critical thinking, written and verbal skills.
  • Work independently and within a team environment.
  • Able to manage multiple projects and related tasks; independently able to prioritize work to meet critical deadlines.
  • Able to coordinate and lead change across an organization.
Job Location:
  • Plymouth Meeting, PA
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Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558
[/cta] [/one_third]

Senior Talent Acquisition Specialist

Job Description:

ProgenyHealth is a specializing in care management solutions for infants in intensive care nurseries. We partner with health plans and employer groups and their neonatal providers to collaborate in developing a plan of care specific to the needs of each newborn. We work with the plans’ neonatal providers and families from the moment an infant is admitted to the intensive care nursery, through the first year of life.

We have a full-time position available for a Sr. Talent Acquisition Specialist. The candidate will lead the recruiting efforts in a fast-paced growth environment and report to the VP of Human Resources.

Job Responsibilities:
  • Will be responsible for conducting full life cycle recruiting activities to ensure staffing processes align with workforce needs.
  • Will source and attain top talent, keeping an ongoing pipeline.
  • Work closely with hiring managers to assess staffing needs.
  • Utilize tracking systems to monitor and record recruiting activities.
  • Develop job descriptions for new positions.
  • Manage relationships with vendor staffing firms.
Qualifications:
  • A minimum of 5 years of experience conducting full life cycle recruiting activities is required.
  • Successful history of utilization of social media as a recruiting source
  • College degree preferred.
  • SHRM or HRCI certification preferred
  • Experience in healthcare recruiting preferred.
  • Exemplary interpersonal and relationship building skills, and professional presence
  • Strong computer skills and experience utilizing applicant tracking systems.
  • Strong ability to be collaborative and willingness to embrace new challenges in a growing and dynamic environment.
Job Location:
  • Plymouth Meeting, PA


Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558

Utilization Management Associate

Job Description:

The Utilization Management Associate (UMA) will assist the ProgenyHealth UM program by providing administration support to the Utilization Review department. This includes: intake, screening and precertification of appropriate healthcare services. They will also be responsible for assisting the Clinical Care Nurses with clerical tasks associated with discharge planning/utilization review functions. The UMA will report to the Supervisor of Utilization Review.

Job Responsibilities:
  • Monitor Member eligibility
  • Perform outreach calls to hospitals for follow-up clinical information and discharge info
  • Process new admissions: this includes update of patient demographics; create new case in BabyTrax®; document new case in client system; assign Clinical Care nurse
  • Communicate verbally and/or written prior auths based on client specifications
  • Skilled Nursing visits: receive request and complete referral form; document in BabyTrax; create outpatient case and assign to appropriate Clinical Care nurse
  • Receive incoming calls for UM and refer to appropriate staff member
  • Adheres to policies, procedures and regulations to ensure compliance and patient safety.
  • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
  • Provides additional support and project work within the various Care Management areas of accountability as needed.
Qualifications:
  • 1 – 3 years of experience in customer service in a healthcare environment.
  • HS diploma or equivalent required. College degree preferred.
  • Insurance/payor experience preferred.
  • Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas as well as interact professionally and effectively with members, clients, and staff from all departments within and outside the company.
  • Problem solving skills with the ability to look for root causes and implementable, workable solutions.
  • Must be proficient at an intermediate to advanced level in Outlook, Excel, PowerPoint, & Word.
  • Must be fluent in English. Proficiency in a second language is highly desirable.
  • Must be self-motivated and willing to learn multiple tasks.
  • Must be well-organized and able to prioritize tasks.
  • Must have commitment to excellence in customer service.
Job Location:
  • Plymouth Meeting, PA


Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558

Utilization Management/Concurrent Review Nurse – 100% Telecommute

Job Description:

Clinical care nurses coordinate overall member care, from pre-admission, continued stay (concurrent review) and any outpatient services utilizing a pro-active, evidence-based decision making process that is physician sensitive and attaining quality outcomes for the members. The clinical care nurse serves as a nurse reviewer for admissions, lengths of stay and a facilitator for discharge planning. This position functions as a liaison between the providers, hospitals and health plans. Responsible for the implementation of client-specific contracted polices, managed care policies and must be very knowledgeable about benefits, criteria and guidelines used for reviews. Must be adept at identifying and referring potential quality of care issues to the Medical Director, client and/or appropriate staff.

Job Responsibilities:
  • Initiating the continuum of care process for neonatal admissions.
  • Interacting telephonically and in writing with hospital staff to collect clinical information for newborns in intensive care nurseries in order to facilitate medical necessity determinations.
  • Coordinating discharge planning needs for newborns being discharged from intensive care nurseries.
  • Authorization of all services requiring prior authorization, based upon health plan specific service agreements
  • Review of all services (readmissions and elective procedures) for first year of life
  • Documenting all activities in the electronic medical record.
Qualifications:
  • Registered Nurse (RN) with a current, unrestricted license is required.
  • Three or more years of clinical experience as a NICU nurse is required.
  • Five (5)+ years experience working in a concurrent review or discharge planning role within a health plan or an acute facility is required.
  • Experience with InterQual and/or MCG is required.
  • Experience with URAC or NCQA standards preferred.
  • Data entry skills required.
  • Must be comfortable with and have good computer skills.
  • Excellent communication skills and organizational ability is required.
  • Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks.
  • Must demonstrate accuracy in spelling and documentation. Ability to perform job functions with autonomy and be a self starter. Must possess excellent interpersonal skills, telephone etiquette and maintain positive communication at all times.
  • Must have commitment to excellence in customer service.
Job Location:
  • Plymouth Meeting, PA