Remote Concurrent Review Registered Nurse in Pittsburgh

Job Summary

A healthcare staffing and recruiting firm is seeking a Remote Concurrent Review Registered Nurse in Pittsburgh.

Core Responsibilities Include:

• Performing utilization management and utilization review for prospective (prior authorization), concurrent, or retrospective review
• Determining medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
• Obtaining the information necessary to assess a member's clinical condition, identify ongoing clinical care needs

Qualifications Include:

• Current, valid, and unrestricted state Registered Nurse (R.N.) license.
• 2 years acute care clinical nursing experience
• 1 year of recent experience in Utilization Review or Utilization Management at a health plan or other managed care organization
• Knowledge of guidelines for Medicaid/Medicare and related state programs