Pennsylvania Licensed Utilization Management RN

Job Summary

Evaluating clinical conditions through comprehensive medical record reviews, the remote Pennsylvania Licensed Utilization Management RN will determine medical necessity for services using advanced clinical knowledge and evidence-based criteria in a contract position.

Key Responsibilities

• Apply critical thinking and advanced medical knowledge to make case determinations using InterQual and medical policies
• Contact servicing providers to clarify medical necessity for requested services and review treatment plans
• Collaborate with case management staff and physicians to support discharge planning and identify alternative care settings

Required Qualifications

• Minimum of three (3) years of Medical/Surgical nursing experience
• Previous Hospital Utilization Management experience required
• InterQual experience required
• Must have an active PA RN license or Nurse Licensure Compact to include PA
• Candidate must reside in the tri-state area (PA, DE, NJ)