Utilization Review RN

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

HealthCare Support Staffing, Inc. (HSS). . . (truncated for brevity)

Job Description

• Evaluate clinical information submitted by providers against plan review criteria and benefit guidelines
• Utilize clinical information to determine if criteria for medical necessity and benefit guidelines are met
• Document pertinent case information for approvals and denials—refer cases failing to meet Interqual to Medical Director
• Act as liaison to ensure services are provided in the least restrictive, most cost effective and clinically appropriate setting
• ID and resolve problems that could interfere with provider’s continuity and coordination of care of members—refer unresolved problems to the manager

Qualifications

• Clear and active RN license in state of PA
• Minimum AS in nursing
• 2 years’ experience in acute care hospital
• 2 years’ experience in managed care, quality assurance or utilization review setting

Additional Information

Hours for this Position:

40 hours a week

M-F, daytime hours

Advantages of this Opportunity:

• Competitive salary, negotiable based on relevant experience
• Benefits offered, Medical, Dental, and Vision
• Fun and positive work environment
• Right to Hire opportunity
• Can start as early as next week

Interested in being considered?

If you are interested in applying to this position, please contact Steph Zymowski at 407-636-7030 ext.220 and click the Green I’m Interested Button to email your resume.