Pennsylvania Licensed Utilization Management RN
Job Summary
Evaluating clinical conditions remotely, the part-time Pennsylvania Licensed Utilization Management RN will review medical records to determine the medical necessity of services and authorize care as needed while maintaining regulatory compliance.
Key Responsibilities
- Applies critical thinking and advanced medical knowledge to assess cases and make determinations based on established criteria
- Contacts providers to clarify treatment plans and ensure medical necessity for requested services
- Identifies cases requiring further evaluation by the Medical Director and collaborates with case management staff for discharge planning
Required Qualifications
- Active Pennsylvania RN license or compact including PA
- Utilization Management experience with outpatient, chemotherapy, or infusion center cases
- Preferred experience with InterQual criteria
- Must reside in Pennsylvania, Delaware, or New Jersey
Complete Job Description
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