RN Care Managmnt Coordinator Job at IntePros, Philadelphia, PA

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  • IntePros
  • Philadelphia, PA

Job Description

Registered Nurse – Utilization Review (Acute Care Experience Required)

Location: Fully remote (PA RN License Required)

Schedule: Monday – Friday, 8:45 AM – 5:00 PM; required to work every 4th Saturday

Position Overview:

We are seeking a skilled and detail-oriented Registered Nurse (RN) with a valid PA license to join our team in a Utilization Review capacity. This position is ideal for an RN with direct acute hospital experience or prior work in insurance utilization review. This is not a Case Management or Home Care nursing role—applicants must have hands-on acute hospital experience to be considered.

Key Responsibilities:

  • Conduct clinical reviews to determine medical necessity and appropriateness of care
  • Apply evidence-based criteria to assess patient treatment plans and services
  • Collaborate with healthcare providers and insurance partners to ensure efficient, quality patient care
  • Document review findings accurately and in a timely manner
  • Maintain compliance with internal and external regulatory standards

Required Qualifications:

  • Active and unrestricted PA RN license
  • 3–5 years of recent direct care experience in an acute hospital setting (ICU, ED, Med/Surg, etc.)
  • OR prior experience in insurance utilization review or hospital-based utilization management
  • Strong clinical judgment and knowledge of hospital workflows
  • Proficient in using clinical review tools and electronic health records

Preferred Experience:

  • Prior work in payer-side utilization review is highly desirable
  • Familiarity with InterQual or Milliman criteria

Work Schedule:

  • Monday through Friday, 8:45 AM – 5:00 PM
  • Required to work every 4th Saturday of the month

Job Tags

Saturday, Monday to Friday,

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