Utilization Review Nurse

November 7

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Logo of Netsmart

Netsmart

Electronic Medical Record β€’ Practice Management Software β€’ Local Public Health β€’ Behavioral Health β€’ Vital Records Software

1001 - 5000

Description

β€’ Responsible for utilization review work for emergency admissions and continued stay reviews. β€’ Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual or MCG criteria. β€’ Participate in telephonic discussions with emergency department physicians relative to documentation and admission status. β€’ Enter clinical review information into system for transmission to insurance companies for authorization.

Requirements

β€’ Current RN licensure β€’ At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing β€’ At least 2 years utilization management experience in acute admission and concurrent reviews β€’ Intermediate level experience with InterQual and/or MCG criteria within the last two years β€’ Proficiency in medical record review in an electronic medical record (EMR) β€’ Experience in MS Office and basic Excel β€’ Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs β€’ Passing score(s) on job-related pre-employment assessment(s) β€’ At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing (Preferred) β€’ At least 3 years utilization management experience within the hospital setting (Preferred) β€’ Bachelors of Science in Nursing (Preferred) β€’ Proficient in InterQual/MCG criteria (Preferred) β€’ Case Management Certification (CCM, ACM, CMCN, or CMGT-BC) (Preferred)

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