Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse with at least 5 years of acute care nursing experience to perform admission and continued stay reviews remotely.

Key Responsibilities:

• 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 regarding documentation and admission status
• Enter clinical review information into the system for transmission to insurance companies for authorization

Required Qualifications:

• Current RN licensure
• At least 5 years of clinical experience in an acute care setting, such as the emergency room, critical care, or medical/surgical nursing
• At least 3 years of case management, concurrent review, or utilization management experience
• Experience with InterQual and/or MCG criteria
• Proficiency in medical record review