More jobs:
Utilization Review Nurse
Job in
Reading, Berks County, Pennsylvania, 19610, USA
Listed on 2026-07-01
Listing for:
IntePros
Full Time
position Listed on 2026-07-01
Job specializations:
-
Healthcare
Healthcare Nursing, Nursing Home
Job Description & How to Apply Below
Location:
Fully remote (PA RN License or Compact including PA Required), Must Reside in PA, NJ, or DE
Employment type:Contract to full-time hire
Position Overview:We are seeking a skilled and detail-oriented Utilization Review RN with a valid PA license (or Compact) to join our team. This position is ideal for an RN with prior work in insurance utilization review.
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
- Active and unrestricted PA RN license (or Compact license including PA)
- 2-5+ years ofprior experience in insurance utilization review
- Strong clinical judgment and knowledge of hospital workflows
- Proficient in using clinical review tools and electronic health records
- Familiarity with Inter Qual or Milliman criteria.
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