Job Title: Utilization Management RN
Location: Remote – must reside within the PA/NJ/DE tri-state area for potential conversion to full-time
License Requirement: Active Pennsylvania RN license or Nurse Licensure Compact (including PA) required
Overview
The Utilization Management RN plays a vital role in evaluating members’ clinical conditions through detailed medical record review to determine medical necessity for services. Using advanced clinical knowledge and independent analysis, this position applies appropriate medical criteria to support high-quality, cost-effective care decisions.
This is a remote position with the opportunity for future on-site conversion.
Key Responsibilities
Education/Licensure & Experience
Knowledge, Skills & Abilities
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