Remote Hospital Utilization Management Nurse – Pennsylvania Clinical Review RN

Remote Hospital Utilization Management Nurse – Pennsylvania Clinical Review RN

Company: Keystone Virtual Healthcare Review

Location: Pennsylvania, United States (Remote)

Keystone Virtual Healthcare Review is seeking an experienced Registered Nurse to join our remote Utilization Management team. The Utilization Management Nurse reviews clinical information, evaluates healthcare services, and supports appropriate patient care decisions through evidence-based review processes.

This remote nursing role collaborates with providers, health plans, and healthcare teams to promote quality care, efficient resource utilization, and improved patient outcomes.

Responsibilities

• Perform clinical utilization reviews
• Review medical records and healthcare documentation
• Evaluate medical necessity criteria
• Collaborate with physicians and healthcare professionals
• Document clinical review decisions
• Support quality improvement initiatives
• Communicate review findings effectively
• Maintain compliance with healthcare guidelines

Qualifications

• Active Registered Nurse (RN) license
• Pennsylvania RN license preferred
• Clinical nursing experience required
• Utilization management experience preferred
• Strong analytical and decision-making skills
• Experience reviewing medical records

Preferred Experience

• Utilization management nursing
• Case management
• Hospital clinical review
• Insurance healthcare review

Technology Used

• Electronic health records
• Utilization review platforms
• Clinical decision support tools
• Secure healthcare systems

Schedule

Full-time remote nursing position with weekday scheduling and flexible review assignments.

Benefits

• Medical Insurance
• Dental Insurance
• Vision Insurance
• 401(k) Retirement Plan
• Paid Time Off
• RN Certification Support
• Continuing Education Benefits
• Remote Technology Package
• Performance Bonus

Why Join Keystone Virtual Healthcare Review?

Keystone Virtual Healthcare Review provides expert clinical review services that help healthcare organizations improve quality, efficiency, and patient care. Our remote nursing professionals make healthcare decisions more connected and effective.

Keystone Virtual Healthcare Review is an Equal Opportunity Employer. Applicants from Philadelphia, Pittsburgh, Allentown, Erie, Harrisburg, and communities throughout Pennsylvania are encouraged to apply.