Pennsylvania Licensed Prior Authorization RN

Job Summary

A company is looking for a Prior Authorization RN.

Key Responsibilities

• Conduct comprehensive clinical evaluations to determine medical necessity of services
• Communicate with healthcare providers to clarify treatment plans and validate medical need
• Collaborate with case management staff to facilitate discharge planning and care coordination

Required Qualifications

• Registered Nurse (RN) license
• Experience in clinical evaluations and medical necessity determinations
• Knowledge of InterQual criteria and medical policy standards
• Experience in healthcare provider communication and care coordination
• Understanding of regulatory compliance in utilization management