Remote Utilization Review Nurse: Evidence-Based UR

Netsmart; United States; À distance; USD 90 000 - 120 000; Plein temps

Résumé du poste

Netsmart is seeking a registered nurse to perform utilization review for emergency department admissions and ongoing stay reviews. You will evaluate EMRs, apply InterQual/MCG criteria, and collaborate with ED physicians to determine admission status.

This remote-friendly role requires 3+ years acute care and 2+ years utilization management, with BSN preferred. You will document reviews for insurer authorization and monitor utilization patterns across shifts.

Qualifications

• Current and unrestricted RN license.
• At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
• At least 2 years utilization management experience in acute admission and concurrent reviews
• Intermediate level experience with InterQual and/or MCG criteria within the last two years
• Proficiency in medical record review in an electronic medical record (EMR)
• Experience in Microsoft Suite including Office and basic Excel
• Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs
• Passing score(s) on job-related pre-employment assessment(s)

Responsabilités

• Review and evaluate electronic medical records of emergency department 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 emergency department physicians relative to documentation and admission status
• Enter clinical review information into system for transmission to insurance companies for authorization
• Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources

Formation

Bachelor's of Science in Nursing (BSN)

Outils

InterQual

MCG criteria

Description du poste

Netsmart is seeking a registered nurse to perform utilization review for emergency department admissions and ongoing stay reviews. You will evaluate EMRs, apply InterQual/MCG criteria, and collaborate with ED physicians to determine admission status.

This remote-friendly role requires 3+ years acute care and 2+ years utilization management, with BSN preferred. You will document reviews for insurer authorization and monitor utilization patterns across shifts.