Remote Concurrent Review Registered Nurse in Pittsburgh

Job is Expired
Location: Pennsylvania
Compensation: To Be Discussed
Staff Reviewed: Tue, Jan 18, 2022
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
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