Licensed Utilization Review Nurse
Job Summary
Responsible for utilization review work for emergency admissions and continued stay reviews, the full-time Licensed Utilization Review Nurse will evaluate electronic medical records, apply clinical guidelines, and engage in telephonic discussions with physicians while working remotely.
Key responsibilities
- Review and evaluate electronic medical records for emergency department admissions to assess medical necessity using InterQual or MCG criteria
- Participate in telephonic discussions with emergency department physicians regarding documentation and admission status
- Analyze utilization patterns and trends to identify issues related to resource utilization
Required qualifications
- Current and unrestricted RN license
- At least 3 years of clinical experience in an acute care setting, such as emergency room or critical care
- A minimum of 2 years of 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) system
Complete Job Description
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