RN Care Managmnt Coordinator Job at IntePros, Philadelphia, PA

WU5MTmlpL0JHbUNFb1lVaVpSa0JnKzdia1E9PQ==
  • 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

Saturday, Monday to Friday,

Similar Jobs

Appliance Center

Appliance Installer Job at Appliance Center

 ...Signing bonus ~ Training & development Job Summary Appliance Center is Ohio's largest Furniture, Appliance and Mattress superstore...  ...are actively seeking qualified candidates to fill Appliance Installer positions within our 60 year old local company. This position... 

Wisconsin - KFC

Team Member 1 Job at Wisconsin - KFC

 ...leader in the industry, owns nearly 60,000 restaurants globally, including over 30,000 KFC locations worldwide, along with Taco Bell, Pizza Hut, and The Habit Burger Grill. As the world's largest restaurant company, Yum! Brands opens a new restaurant approximately every two... 

Belcan

Laboratory Technician Job at Belcan

Benefits: On the job training, with cross training for other skilled positions and opportunities for advancement. The aerospace business is growing and we are continually training and promoting up from within. *Medical, Dental, Vision, Retirement savings options, tuition...

Century Communities

Purchasing Manager Job at Century Communities

DescriptionPosition at Century CommunitiesWhat Youll Do:The Purchasing Manager is responsible for managing the originating and negotiating the procurement activities of trade goods and services.Your Key Responsibilities Include:~Provide new community... 

Star Health

Healthcare Recruiter Job at Star Health

Star Health is hiring an experienced Healthcare Recruiter to contact and screen candidates to determine if they meet the criteria for successful...  ....We will give you immediate searches to work on.It is a remote position, so you won't have to move or commute.You won't...