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State Licensed Utilization Review Nurse
Job Summary
A company is looking for a Utilization Review Nurse, Full-Time (9a-9p EST), Remote.
Key Responsibilities
- Review and evaluate electronic medical records for emergency department admissions to assess medical necessity
- Apply clinical guidelines to ensure proper utilization of healthcare resources and participate in discussions with emergency department physicians
- Enter clinical review information into the system for insurance authorization and analyze utilization patterns and trends
Required Qualifications
- Current and unrestricted RN license
- At least 3 years of clinical experience in an acute care setting, particularly in emergency room, critical care, or medical/surgical nursing
- At least 2 years of utilization management experience in acute admission and concurrent reviews
- Intermediate experience with InterQual and/or MCG criteria within the last two years
- Proficiency in medical record review in an electronic medical record (EMR) system
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COMPLETE JOB DESCRIPTION
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