Pennsylvania Licensed Registered Nurse

Job Summary

To support a remote contract opportunity, a Pennsylvania Licensed Registered Nurse will review medical records to assess clinical conditions, determine medical necessity for services, and collaborate with healthcare providers while ensuring regulatory compliance.

Key responsibilities

• Apply critical thinking and medical knowledge to assess cases and determine medical appropriateness using established guidelines
• Collaborate with providers to clarify treatment plans and escalate non-qualifying cases to the Medical Director
• Ensure compliance with state, federal, and accreditation regulations while maintaining accurate documentation and data entry

Required qualifications

• Current, active, and unrestricted Pennsylvania Registered Nurse licensure
• Three years of clinical, case management, or disease management experience
• Utilization management experience in either outpatient or inpatient settings
• Minimum of three years of acute care clinical experience in a healthcare setting
• Prior discharge planning and/or utilization management experience is desirable