Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse, PRN, Remote.

Key Responsibilities

• Review and evaluate electronic medical records for emergency admissions and assess medical necessity using InterQual or MCG criteria
• Apply evidence-based clinical guidelines to ensure proper utilization of healthcare resources
• Participate in 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, preferably in emergency room or critical care
• At least 2 years of utilization management experience in acute admissions 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)