RN/LPN Clinical Care Reviewer — Utilization Mgmt (Contract)

Zolontech; Philadelphia (Philadelphia County); On-site; USD 70,000 - 90,000; Full time

Job summary

Zolontech is seeking an RN/LPN Clinical Care Reviewer in Philadelphia, PA. This role is contract-to-hire, requiring 3+ years of critical care experience and a current PA nursing license.

The Clinical Care Reviewer will evaluate medical necessity reviews, apply clinical judgment, and ensure appropriate services are approved based on benefit policies. Strong proficiency in MS Office is also required.

This opportunity offers a chance to work with a leading firm serving federal clients in IT and healthcare sectors.

Qualifications

• Current, unrestricted PA Registered Nurse/LPN license.
• 3+ years' experience in critical care or ER within an acute care environment.
• 2+ years' experience in utilization management, preferably within managed care.

Responsibilities

• Complete medical necessity reviews under Supervisory direction.
• Evaluate requests for inpatient and outpatient services.
• Maintain knowledge of laws and regulations relevant to the role.

Skills

Critical care experience

Utilization management

MS Office proficiency

Education

Current PA Registered Nurse/LPN license

Tools

Excel

Word

Outlook

Job description

Zolontech is seeking an RN/LPN Clinical Care Reviewer in Philadelphia, PA. This role is contract-to-hire, requiring 3+ years of critical care experience and a current PA nursing license.

The Clinical Care Reviewer will evaluate medical necessity reviews, apply clinical judgment, and ensure appropriate services are approved based on benefit policies. Strong proficiency in MS Office is also required.

This opportunity offers a chance to work with a leading firm serving federal clients in IT and healthcare sectors.