Pennsylvania Licensed RN for Utilization Management

Job Summary

To support utilization management efforts, the part-time Pennsylvania Licensed RN for Utilization Management will review patient medical records, craft appeal letters, and utilize coding guidelines while working remotely.

Key responsibilities

• Review and extract pertinent details from patient medical records to support appeal processes
• Compose well-structured appeal letters using evidence-based medical literature and coding guidelines
• Collaborate with peers to ensure effective communication and adherence to company policies

Required qualifications

• Associates degree or higher
• Unrestricted RN license in the state of residence
• 3+ years of clinical experience in ED/Telemetry/Critical Care
• 2+ years of experience in clinical validation appeals