RN Care Managmnt Coordinator Job at IntePros, Philadelphia, PA

cm1KanJmY2RDOW1mcVVXRW5sbGpaQnhZaUE9PQ==
  • IntePros
  • Philadelphia, PA

Job Description

Registered Nurse – Utilization Review (Acute Care Experience Required)

Location: Fully remote (PA RN License Required)

Schedule: Monday – Friday, 8:45 AM – 5:00 PM; required to work every 4th Saturday

Position Overview:

We are seeking a skilled and detail-oriented Registered Nurse (RN) with a valid PA license to join our team in a Utilization Review capacity. This position is ideal for an RN with direct acute hospital experience or prior work in insurance utilization review. This is not a Case Management or Home Care nursing role—applicants must have hands-on acute hospital experience to be considered.

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
  • 3–5 years of recent direct care experience in an acute hospital setting (ICU, ED, Med/Surg, etc.)
  • OR prior experience in insurance utilization review or hospital-based utilization management
  • Strong clinical judgment and knowledge of hospital workflows
  • Proficient in using clinical review tools and electronic health records

Preferred Experience:

  • Prior work in payer-side utilization review is highly desirable
  • Familiarity with InterQual or Milliman criteria

Work Schedule:

  • Monday through Friday, 8:45 AM – 5:00 PM
  • Required to work every 4th Saturday of the month

Job Tags

Remote work, Saturday, Monday to Friday,

Similar Jobs

Yexgo

Part time, Remote Data Entry Clerk - Work From Home Job at Yexgo

 ...Job Description We are in search of diligent, detail-oriented individuals to join our team as Remote Entry-Level Data Entry Clerks. If you have a passion for precision and thrive in independent work environments, this opportunity might be your ideal fit. Come join... 

Tandym Group

Medical Billing Specialist Job at Tandym Group

 ...Group has several immediate opportunities for A/R Billing Specialists with a client in Pennsylvania. These contracts will be 100% remote. These roles will focus specifically on A/R billing, claims processing, billing adjustments, and revenue integrity, with a strong emphasis... 

Actalent

Program Lead, Systems & Software Engineering Services Job at Actalent

 ...onsite client-facing and internal communications to drive successful delivery operations. Primary responsibilities include managing engineering consultant onboarding, on-going performance of individual consultants, contractually required deliverables, operations and... 

ColumbiaCare Services

Mental Health Associate - 5053 Job at ColumbiaCare Services

 ...illness. Their primary responsibilities include supporting the development of life skills and therapeutic interventions, performing housekeeping and meal preparation, administering medication, and keeping accurate clinical documentation. If you have experience working as a... 

PureSpectrum

Services Associate - Entry Level Project Manager Job at PureSpectrum

 ...PureSpectrum also developed the industrys first and only respondent-level scoring system, PureScore. Most recently, PureSpectrum was...  ...Associate Director, Services, gaining valuable mentorship. This entry-level role is perfect for a quick learner eager to grow in market...