Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse, part-time, remote.

Key Responsibilities

• Review and evaluate electronic medical records of emergency department admissions for medical necessity using InterQual or MCG criteria
• Apply evidence-based clinical guidelines to assess and ensure proper utilization of healthcare resources
• Participate in telephonic discussions with emergency department physicians regarding documentation and admission status

Required Qualifications

• Current and unrestricted RN license
• At least 3 years clinical experience in an acute care setting, specifically in emergency room, critical care, or medical/surgical nursing
• At least 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)