Pennsylvania Licensed Utilization Management RN

To support clinical utilization review and care management activities, the part-time remote Pennsylvania Licensed Utilization Management RN will independently review medical records, assess medical necessity, and collaborate with providers and Medical Directors to ensure appropriate patient care. Key Responsibilities Conduct comprehensive clinical reviews of medical records to determine medical necessity Utilize established clinical criteria and resources to evaluate cases and authorize medically necessary services Collaborate with Case Management staff and physicians to facilitate timely discharge and identify alternative levels of care Required Qualifications Active Pennsylvania RN license or Nurse Licensure Compact license that includes Pennsylvania Minimum of 3 years of Medical-Surgical clinical nursing experience Previous Utilization Management and/or discharge planning experience preferred Experience with InterQual or MCG (formerly Milliman) preferred Proficiency with Microsoft Word, Outlook, Excel, SharePoint, and Adobe