Key skills
Collaboration
About this role
Role Overview
- performs utilization review, medical necessity assessments, and authorization activities to promote quality outcomes, timely reimbursement, and effective care transitions
- reviewing clinical documentation, verifying coverage and certification requirements
- collaborating with physicians and care teams
- maintaining accurate utilization review records, supporting documentation integrity, and ensuring compliance with state, federal, and third-party payer standards
- identifying and notifying appropriate staff regarding discrepancy issues with third party payer health insurance coverage and lack of coverage
Requirements
- At least three (3) years of RN work experience is required
- Previous experience in an acute care setting is highly preferred
- Previous Utilization Management experience is highly preferred
- BSN is preferred
- Graduate from Specialty Training Program-Nursing (Required)
- Licensed Registered Nurse (Pennsylvania)
- RN_State of Pennsylvania
Benefits
- healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners
- encourages an atmosphere of collaboration, cooperation and collegiality.