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The professional registered nurse Outpatient RN CAP 1 is an entry level designation into the Clinical Advancement Program (CAP).This position is accountable and responsible for the provision and coordination of clinically competent care including assessment, planning, intervention and evaluation for

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 • Apply critical thinking and clinical judgment to determine medical necessity using tools such as InterQual, Care Management Policy, and Medical Policy guidelines., • Review and evaluate medical records, treatment plans, and histories to determine the appropriateness of inpatient, outpatient, and ancillary services., • Contact providers to clarify or obtain additional clinical information as needed., • Independently authorize medically necessary services based on established criteria., • Refer cases that do not meet criteria to the Medical Director for further review., • Identify members in need of discharge planning and collaborate with case management and physicians to ensure safe transitions of care., • Maintain compliance with federal, state, and accreditation regulations and company policies., • Document all utilization management activities accurately and timely per departmental procedures., • Report potential utilization trends or issues to management with recommendations for improvement., • Refer cases appropriately to Case Management, Disease Management, or Quality Management as indicated., • Meet or exceed departmental productivity and turnaround time (TAT) goals. Education/Licensure & Experience • Active PA Licensed RN (or Compact License including PA) – required, • BSN preferred, • Minimum of 3 years of acute care clinical experience (hospital or healthcare setting), • Discharge planning and/or utilization management experience preferred, • Prior medical management or precertification experience a plus

The professional registered nurse Outpatient RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for new employees who meet the RN CAP 2 criteria or attained through advancement from RN CAP 1. This may include delegation of appropriate tasks to direct patient care

Acts as a resource for the patient to address patient concerns and questions. Assists the physician in completing and reporting state required adverse event reports and reporting internally as per organization/FMC policy and procedure. Ensures all blood spills are immediately addressed according to

DescriptionRN for Oral & Maxillofacial Surgery PracticeMinimum Qualifications:RN license in PAWillingness to learn and progress along our training trackExperience using various patient monitoring software and technical solutionsStrong written and verbal communication skillsConsistent professional ap

PURPOSE AND SCOPE: The professional registered nurse Outpatient RN CAP 1 is an entry level designation into the Clinical Advancement Program (CAP). Assesses, collaborates, and documents patient/family’s basic learning needs to provide initial and ongoing education to patients and family. SUPERVISI