Utilization Review Nurse, PRN

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess and review electronic medical records for admissions to the emergency department.

• Evaluate admissions for medical necessity utilizing InterQual or MCG criteria.

• Implement evidence-based clinical guidelines and criteria to ensure effective use of healthcare resources.

• Engage in telephonic discussions with emergency department physicians regarding documentation and admission status.

• Input clinical review data into the system for submission to insurance providers for authorization.

• Analyze and identify utilization trends, issues, or inappropriate use of resources.

⛳️ Requirements

• Active and unrestricted RN license.

• Minimum of 3 years (36 months) clinical experience in an acute care environment, specifically in emergency room, critical care, and/or medical/surgical nursing.

• At least 2 years of experience in utilization management focused on acute admissions and concurrent reviews.

• Intermediate-level familiarity with InterQual and/or MCG criteria within the past two years.

• Skilled in medical record review within an electronic medical record (EMR) system.

• Proficient with Microsoft Suite, including Office and basic Excel functionalities.

• Ability to excel in a fast-paced, dynamic environment and adapt to frequently changing business requirements.

• Successful completion of job-related pre-employment assessments.

• All candidates must be legally authorized to work in the United States.

• Netsmart does not offer work visa sponsorship for this role.

• Comfortable with remote working conditions and virtual collaboration tools.

• Physical requirements include prolonged periods of sitting, computer usage, and telephone communication.

• Preferred: a minimum of 5 years of clinical experience in an acute care setting.

• Preferred: at least 3 years of utilization management experience within a hospital environment.

• Preferred: Bachelor of Science in Nursing (BSN).

• Preferred: case management certifications such as CCM, ACM, CMCN, or CMGT-BC.

🏝️ Benefits

• Remote work options available.

• Access to virtual collaboration tools.

• Pre-employment background check and drug screening covered by Netsmart.

• Equal opportunities for employment and advancement.

• Supportive and inclusive workplace culture.