Pennsylvania Licensed Care Management RN

Job Summary

Working remotely on a contract basis, a Pennsylvania Licensed Care Management RN will evaluate members' clinical conditions, interact with providers for additional clinical information, and ensure compliance with medical appropriateness for treatment plans.

Key responsibilities

• Evaluate members' clinical conditions through medical record reviews and direct provider interactions
• Utilize resources to determine the medical appropriateness of proposed treatment plans and clarify medical needs with providers
• Identify and refer cases that do not meet established criteria to the Medical Director for further evaluation

Required qualifications

• Registered Nurse with a BSN preferred
• Minimum of three (3) years of acute care clinical experience in a hospital or other healthcare setting
• Outpatient experience in chemotherapy, office, or infusion center preferred
• Prior authorization experience is highly desirable