Remote RN: Utilization Review & Care Coordination

Penn Medicine; Bala Cynwyd (PA); On-site; USD 80,000 - 110,000; Full time

Job summary

Penn Medicine is seeking a Utilization Review Nurse to support timely and accurate utilization reviews, patient status determinations, and regulatory compliance within the centralized Utilization Management department. Collaboration with physicians, case management, and interdisciplinary teams is essential to promote appropriate level-of-care and efficient resource use.

Responsibilities include conducting reviews, managing authorizations, documenting activities, and ensuring CMS and payer

Qualifications

• Registered Nurse (RN) is required.
• 2+ years of Acute Hospital Care experience is required.
• Experience with medical necessity determinations and utilization review frameworks is expected.

Responsibilities

• Conduct medical necessity reviews and patient status determinations using clinical criteria and regulatory requirements.
• Perform admission, concurrent, continued stay, and retrospective utilization reviews.
• Manage payer authorization and notification processes to promote timely approvals and reduce financial risk.
• Identify cases requiring secondary review or physician advisor involvement.
• Collaborate with physicians, case managers, social workers, and care teams to support discharge planning and progression.
• Ensure accurate documentation of utilization review activities and payer communications.
• Assist with denial prevention through documentation, authorization, and status monitoring.
• Monitor CMS regulations, payer requirements, accreditation standards, and utilization management workflows.
• Perform duties in line with Penn Medicine values and related policies.

Skills

Utilization review

Education

Bachelor's degree

Tools

Interqual

MCG

Job description

Penn Medicine is seeking a Utilization Review Nurse to support timely and accurate utilization reviews, patient status determinations, and regulatory compliance within the centralized Utilization Management department. Collaboration with physicians, case management, and interdisciplinary teams is essential to promote appropriate level-of-care and efficient resource use.

Responsibilities include conducting reviews, managing authorizations, documenting activities, and ensuring CMS and payer