Remote Utilization Review Nurse — Acute Care Focus

Netsmart Technologies, Inc.; United States; Remote; USD 75,000 - 110,000; Full time

Benefits offered by this job

Remote-friendly work arrangements

Job summary

Netsmart Technologies, Inc. is seeking a Registered Nurse with utilization management experience to review ED admissions and apply InterQual/MCG criteria for medical necessity. You will discuss documentation with ED physicians and ensure proper authorization through EMR-based workflows.

Ideal candidates have 3+ years in acute care nursing and 2+ years in utilization management, with proficiency in EMR and MS Office. Remote work arrangements are supported where appropriate.

Qualifications

• Current and unrestricted RN license.
• At least 3 years clinical experience in acute care settings (ER/ICU/med-surg).
• At least 2 years utilization management experience in acute admission and concurrent reviews.
• InterQual and/or MCG criteria experience within the last two years.
• Proficiency in medical record review in an EMR.
• Experience with Microsoft Office including basic Excel.
• Ability to thrive in a fast-paced, dynamic environment and adapt to changing business needs.
• Passing score(s) on pre-employment assessments.

Responsibilities

• Review and evaluate electronic medical records of ED admissions and screen for medical necessity using InterQual or MCG criteria.
• Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources.
• Participate in telephonic discussions with ED physicians regarding documentation and admission status.
• Enter clinical review information into the system for transmission to insurance companies for authorization.
• Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources.

Tools

EMR systems

Microsoft Office

Excel

Job description

Netsmart Technologies, Inc. is seeking a Registered Nurse with utilization management experience to review ED admissions and apply InterQual/MCG criteria for medical necessity. You will discuss documentation with ED physicians and ensure proper authorization through EMR-based workflows.

Ideal candidates have 3+ years in acute care nursing and 2+ years in utilization management, with proficiency in EMR and MS Office. Remote work arrangements are supported where appropriate.