Registered Nurse; RN), Utilization Review

As the RN Utilization Review nurse, you will be responsible for conducting and documenting medical necessity reviews using our utilization review process. You will review records, applying medical necessity criteria along with insurance guidelines, to support the decision to admit patients and for continued stay. You will be responsible for working with insurance companies to secure insurance authorization for patient stays along with preauthorization for procedures and treatments.

You will also assist in insurance denials management and collaborate with the Physician Advisors through the appeal process, as necessary.

***$20,000 SIGN-ON/RETENTION BONUS AVAILABLE FOR QUALIFIED CANDIDATES***

• Must be a Registered Nurse with a valid PA Nursing License
• Must exercise critical assessment skills to solve issues
• Must demonstrate excellent clinical knowledge and be able to perform assessments and evaluate services
• Must have excellent interpersonal competence to interact with providers and payers
• Must demonstrate the ability to prioritize workload and manage time efficiently
• Three (3) years acute care experience, preferred
• Proficiency in Microsoft, Outlook, Cerner and insurance portals, preferred

• Competitive Compensation based on experience
• Professional Development
• Supportive and Experienced Peers

• Medical, Dental, and Vision offered the first month after start date
• Paid Time Off
• 403(b) retirement plan with company match
• Flex Spending Account
• 25% discount on all services at Penn Highlands Healthcare facilities
• Employee Assistance Program (EAP)
• Health & Wellness Programs