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.