RN Utilization Review Specialist – Managed Care

Healthcare Support Staffing; Philadelphia (Philadelphia County); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Competitive salary

Medical, Dental, and Vision benefits

Fun and positive work environment

Right to Hire opportunity

Job summary

A health staffing organization is hiring a Clinical Evaluator in Philadelphia. The role involves evaluating clinical information against review criteria and documenting case details. Candidates must possess a clear RN license in Pennsylvania and an Associate's Degree in Nursing along with relevant experience in acute care. The position offers a competitive salary, benefits including medical, dental, and vision, a fun work environment, and a right-to-hire opportunity.

Qualifications

• Must have a clear and active RN license in the state of PA.
• Minimum AS in nursing is required.
• At least 2 years of experience in an acute care hospital setting.

Responsibilities

• Evaluate clinical information against plan review criteria.
• Utilize data to determine medical necessity.
• Document case information for approvals and denials.

Skills

Clinical evaluation

Documentation

Problem-solving

Liaison skills

Education

Associate's Degree in Nursing

Clear and active RN license in Pennsylvania

Job description

A health staffing organization is hiring a Clinical Evaluator in Philadelphia. The role involves evaluating clinical information against review criteria and documenting case details. Candidates must possess a clear RN license in Pennsylvania and an Associate's Degree in Nursing along with relevant experience in acute care. The position offers a competitive salary, benefits including medical, dental, and vision, a fun work environment, and a right-to-hire opportunity.