Utilization Review Nurse

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Electronic Medical Record • Practice Management Software • Local Public Health • Behavioral Health • Vital Records Software

1001 - 5000

Description

• Responsible for utilization review work for emergency admissions and continued stay reviews. • Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual or MCG criteria. • 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.

Requirements

• Current RN licensure • 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 MS 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) • At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing (Preferred) • At least 3 years utilization management experience within the hospital setting (Preferred) • Bachelors of Science in Nursing (Preferred) • Proficient in InterQual/MCG criteria (Preferred) • Case Management Certification (CCM, ACM, CMCN, or CMGT-BC) (Preferred)