Remote ER Utilization Review Nurse - Evidence-Based Care

Netsmart Technologies, Inc.; United States; À distance; USD 75 000 - 110 000; Plein temps

Résumé du poste

Netsmart Technologies, Inc. is seeking an experienced Utilization Review Nurse in the United States to evaluate ED admissions and ongoing stays using InterQual/MCG criteria. You will assess medical necessity, apply evidence-based guidelines, and discuss admission status with ED physicians.

Responsibilities include documenting reviews for insurer authorization and identifying utilization patterns. The role supports remote work with flexible shifts (9am–9pm EST windows, 8/10/12-hour shifts) and

Qualifications

• Active, unrestricted RN license.
• Minimum 3 years acute care experience in ED/ICU/med-surgical nursing.
• At least 2 years utilization management experience.
• Experience with EMR review and documentation.
• Proficiency with Microsoft Office, including Excel.
• Ability to thrive in a fast-paced, dynamic environment with changing needs.
• Successful completion of pre-employment assessments.

Responsabilités

• Review and evaluate electronic medical records of emergency department admissions for medical necessity.
• Apply evidence-based guidelines to assess utilization of healthcare resources.
• Participate in telephonic discussions with emergency department physicians regarding documentation and admission status.
• Enter clinical review information into the system for transmission to insurance companies for authorization.
• Analyze utilization patterns and identify inappropriate utilization of resources.

Description du poste

Netsmart Technologies, Inc. is seeking an experienced Utilization Review Nurse in the United States to evaluate ED admissions and ongoing stays using InterQual/MCG criteria. You will assess medical necessity, apply evidence-based guidelines, and discuss admission status with ED physicians.

Responsibilities include documenting reviews for insurer authorization and identifying utilization patterns. The role supports remote work with flexible shifts (9am–9pm EST windows, 8/10/12-hour shifts) and