PA Licensed Precertification RN

A company is looking for a Precertification RN.

Key Responsibilities

Evaluate healthcare service requests and apply clinical criteria to determine medical necessity

Collaborate with providers to clarify clinical details and ensure compliance with guidelines

Confirm service coverage, maintain documentation, and monitor utilization trends

Required Qualifications

Must reside in Pennsylvania, New Jersey, or Delaware

Active PA RN or LPN license (Compact licenses not accepted)

Minimum 2 years of acute care experience in a hospital or healthcare setting

Clinical background in orthopedic unit, outpatient ambulatory surgery center, or surgical unit

Prior experience in medical management, precertification, or prior authorization