Remote Utilization Review Nurse — Evidence‑Based Care

Netsmart; United States; À distance; USD 85 000 - 110 000; Plein temps

Avantages offerts par ce poste

Remote-friendly work arrangements

Résumé du poste

Netsmart is seeking a registered nurse to perform utilization management reviews for ED admissions, applying InterQual/MCG criteria and evidence-based guidelines to ensure appropriate resource use.

You will collaborate remotely with ED physicians, document reviews, and transmit authorizations to insurers while analyzing utilization patterns for continuous improvement. ED/ACU and case management experience is preferred.

Qualifications

• Current and unrestricted RN license.
• 3+ years of acute care experience in ER/critical care/medical-surgical.
• 2+ years utilization management in acute admission and concurrent reviews.
• InterQual and/or MCG criteria within the last 2 years.
• Proficiency in medical record review in an EMR.
• Experience with Microsoft Office and basic Excel.
• Ability to thrive in a fast-paced environment and adapt to changing needs.
• Passing scores on pre-employment assessments.

Responsabilités

• Review and evaluate electronic medical records of ED admissions for medical necessity using InterQual/MCG criteria.
• Apply evidence-based guidelines to assess utilization of healthcare resources.
• Discuss with ED physicians regarding documentation and admission status.
• Enter clinical review data into system for transmission to insurers for authorization.
• Analyze utilization patterns and identify inappropriate resource use.

Connaissances

InterQual/MCG criteria

EMR proficiency

Microsoft Excel

Communication

Formation

Active RN license

Outils

InterQual

MCG

EMR software

Description du poste

Netsmart is seeking a registered nurse to perform utilization management reviews for ED admissions, applying InterQual/MCG criteria and evidence-based guidelines to ensure appropriate resource use.

You will collaborate remotely with ED physicians, document reviews, and transmit authorizations to insurers while analyzing utilization patterns for continuous improvement. ED/ACU and case management experience is preferred.