Pennsylvania Licensed Clinical Access RN
Job Summary
Working part-time from home, the Pennsylvania Licensed Clinical Access RN will perform medical necessity reviews and ensure compliance with certification requirements while managing documentation integrity and communication with healthcare teams.
Key responsibilities:
- Conduct initial, concurrent, and retrospective medical record reviews for medical necessity and level of care determination
- Maintain knowledge of third-party payer health plans and regulatory requirements, addressing discrepancies as necessary
- Enter utilization review data into databases for tracking and compliance with audits and billing requirements
Required qualifications:
- Licensed Registered Nurse in Pennsylvania
- Minimum of 3 years of nursing experience required
- Experience in an acute care setting preferred
- Utilization Management experience highly preferred
- Bachelor of Science in Nursing (BSN) preferred
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