Pre Certification RN
Listed on 2026-10-28
-
Nursing
RN Nurse
National Healthcare Recruiting Manager @ The Judge Group | Connecting top healthcare workers with their dream job
Pre-Certification RN
Location:
Remote (must reside in PA, NJ, or DE)
Employment Type: Temporary with potential for permanent placement
Schedule: Monday–Friday, Day Shift
Pay: Up to $45/hour
SummaryThe Pre-Certification RN evaluates members’ clinical conditions through medical record review to determine medical necessity for services. This role applies advanced clinical judgment, interacts with providers for additional information when needed, and authorizes medically necessary services. Cases not meeting criteria are referred to the Medical Director for further evaluation. The RN ensures compliance with federal, state, and accreditation regulations and acts as a patient advocate throughout the care process.
Key Responsibilities- Review medical records to determine medical necessity using Inter Qual and medical policy criteria.
- Authorize services that meet established criteria; refer non-qualifying cases to the Medical Director.
- Communicate with providers to clarify treatment plans and medical needs.
- Ensure requests align with member benefit plans and regulatory requirements.
- Identify discharge planning needs and collaborate with case management staff.
- Maintain accurate documentation and meet turnaround time and productivity goals.
- Report utilization trends and quality-of-care issues as needed.
- Active RN license in PA or Compact license including PA.
- Minimum 3 years of acute care clinical RN experience in a hospital or healthcare setting.
- Prior discharge planning or utilization management experience preferred.
(If this job is in fact in your jurisdiction, then you may be using a Proxy or VPN to access this site, and to progress further, you should change your connectivity to another mobile device or PC).