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Utilization Review Nurse

Utilization Review Nurse – Remote

Location: US National


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.



  • Current RN licensure
  • At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
  • At least 3 years case management, concurrent review or utilization management experience
  • Experience with InterQual and/or MCG criteria
  • Proficiency in medical record review


  • Case management/concurrent review/utilization management experience within the ED setting
  • Bachelors of Science in Nursing


  • This job operates in a remote environment that must be private. This role routinely uses standard office equipment such as computers, phones, and printers.
  • Hours will vary, including two weekends a month.
  • Must be able to remain in a stationary position 50% of the time and constantly operate a computer.
  • Frequently communicates with internal, external and executive personnel and must be able to listen and exchange accurate information.