Utilization Review Nurse

Location: Fully remote (PA RN License or Compact including PA Required), Must Reside in PA, NJ, or DE Employment type: Contract to full-time hire Position Overview: We are seeking a skilled and detail-oriented Utilization Review RN with a valid PA license (or Compact)to join our team. This position is ideal for an RN with prior work in insurance utilization review. Key Responsibilities: Conduct clinical reviews to determine medical necessity and appropriateness of care Apply evidence-based criteria to assess patient treatment plans and services Collaborate with healthcare providers and insurance partners to ensure efficient, quality patient care Document review findings accurately and in a timely manner Maintain compliance with internal and external regulatory standards Required Qualifications: Active and unrestricted PA RN license (or Compact license including PA) 2-5+ years ofprior experience in insurance utilization review Strong clinical judgment and knowledge of hospital workflows Proficient in using clinical review tools and electronic health records Familiarity with InterQual or Milliman criteria. #J-18808-Ljbffr IntePros