Utilization Review Nurse: Optimize Care, Cut Denials

Penn Medicine, University of Pennsylvania Health System; West Chester (Chester County); On-site; USD 70,000 - 90,000; Full time

Job summary

Penn Medicine, part of the University of Pennsylvania Health System, seeks an Utilization Review Nurse to perform authorization, concurrent and discharge reviews using InterQual guidelines to validate medical necessity and ensure appropriate care. You will partner with the care team to manage transitions and align with third-party payors.

Responsibilities include collaboration with physicians, nursing and multidisciplinary staff, identifying barriers, and supporting preceptor roles for new

Qualifications

• Registered Nurse - PA (Required)
• Certified Case Manager (Required)
• ASN/AS degree and BSN with nursing experience and utilization review exposure

Responsibilities

• Provide utilization review for authorization, concurrent review and discharge review using InterQual criteria.
• Collaborate with physicians and care team to ensure appropriate level of care and timely transitions.

Skills

Critical thinking

Leadership

Communication

Education

Associate of Arts or Science (ASN/AS)

Bachelor of Arts or Science (BSN)

Job description

Penn Medicine, part of the University of Pennsylvania Health System, seeks an Utilization Review Nurse to perform authorization, concurrent and discharge reviews using InterQual guidelines to validate medical necessity and ensure appropriate care. You will partner with the care team to manage transitions and align with third-party payors.

Responsibilities include collaboration with physicians, nursing and multidisciplinary staff, identifying barriers, and supporting preceptor roles for new