IntePros
IntePros is an established, woman-owned, privately-held technology and business services consulting agency committed to building long-term relationships and helping more companies leverage the power of a more diverse workforce.
Registered Nurse – Utilization Review (Acute Care Experience Required) Location: Fully remote (PA RN License Required) Schedule: Monday – Friday, 8:45 AM – 5:00 PM; required to work every 4th Saturday Position Overview: We are seeking a skilled and detail-oriented Registered Nurse (RN) with a valid PA license to join our team in a Utilization Review capacity. This position is ideal for an RN with direct acute hospital experience or prior work in insurance utilization review. This is not a Case Management or Home Care nursing role—applicants must have hands-on acute hospital experience to be considered.
Required Qualifications: Active and unrestricted PA RN license 3–5 years of recent direct care experience in an acute hospital setting (ICU, ED, Med/Surg, etc.) OR prior experience in insurance utilization review or hospital-based utilization management Strong clinical judgment and knowledge of hospital workflows Proficient in using clinical review tools and electronic health records Preferred Experience: Prior work in payer-side utilization review is highly desirable Familiarity with InterQual or Milliman criteria Work Schedule: Monday through Friday, 8:45 AM – 5:00 PM Required to work every 4th Saturday of the month
Conduct clinical reviews to determine medical necessity and appropriateness of care Apply evidence-based criteria to assess patient treatment plans and services Collaborate with healthcare providers and insurance partners to ensure efficient, quality patient care Document review findings accurately and in a timely manner Maintain compliance with internal and external regulatory standards
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