Remote Utilization Management RN – InterQual Expert

The Judge Group; Pennsylvania; Remote; USD 85,000 - 110,000; Full time

Job summary

A healthcare staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to reside in PA, DE, or NJ. Key duties involve applying criteria for medical necessity, collaborating with providers, and managing discharge planning. Candidates must have an active PA RN license and a minimum of three years in Medical/Surgical experience, along with proficiency in Microsoft's applications and InterQual criteria.

Qualifications

• Must have an active PA RN license or Nurse Licensure Compact including PA.
• Minimum of three years of Medical/Surgical experience.
• Previous acute hospital utilization management and InterQual experience required.

Responsibilities

• Review medical records and apply criteria for medical necessity.
• Communicate with providers to clarify treatment plans.
• Refer cases to Medical Director for evaluation if criteria are not met.
• Identify discharge planning needs early.
• Report utilization trends and recommend improvements.
• Ensure requests align with member benefit plans.
• Meet turnaround times for processing referrals.
• Maintain accurate documentation.

Skills

Medical/Surgical experience

Utilization Management experience

InterQual experience

Microsoft Word

Outlook

Excel

SharePoint

Adobe

Education

BSN

Job description

A healthcare staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to reside in PA, DE, or NJ. Key duties involve applying criteria for medical necessity, collaborating with providers, and managing discharge planning. Candidates must have an active PA RN license and a minimum of three years in Medical/Surgical experience, along with proficiency in Microsoft's applications and InterQual criteria.