Utilization Review RN

• 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

• Clear and active RN license in state of PA

• Minimum AS in nursing

• 2 years’ experience in acute care hospital AND

• 2 years’ experience in managed care, quality assurance or utilization review setting

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.