Utilization Review Nurse - Full-Time

Responsible for utilization review work for emergency admissions and continued stay reviews Responsibilities • Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteria • Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources • Participate in telephonic discussions with emergency department physicians relative to documentation and admission status • Enter clinical review information into system for transmission to insurance companies for authorization • Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources Qualifications Required • Current and unrestricted RN license • At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing • At least 2 years 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) • Experience in Microsoft Suite including Office and basic Excel • Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs • Passing score(s) on job-related pre-employment assessment(s) Preferred • At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing • At least 3 years utilization management experience within the hospital setting • Bachelor's of Science in Nursing (BSN) • Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), Case Management, Board Certified (CMGT-BC) Expectations • Comfortable with remote work arrangements and virtual collaboration tools • Physical demands include extended periods of sitting, computer use, and telephone communication Shifts Requirements & Needs • Working between the hours of 9am EST and 9pm EST either for 8-hour, 10-hour or 12-hours shifts. • All Full-Time required to work 4 Holidays per year • All Full-time required to work every other weekend or 4 weekend shifts per month. Additional Shifts Available