Utilization Review RN, Full-Time - Day and Evening Shifts Available

Responsible for utilization review work for emergency admissions and reputed company 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 reputed company 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 reputed company 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 reputed company reviews Intermediate level experience with InterQual and/or MCG criteria reputed company the last two years Proficiency in medical record review in an electronic medical record (EMR) Experience in reputed company Suite including Office and basic reputed company Ability to reputed company in a fast-paced, dynamic environment and adapt to frequent changing business needs Passing score(s) on job-reputed company 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 reputed company 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. reputed company Full-Time required to work 4 Holidays per year reputed company Full-time required to work every other weekend of 4 weekend shifts per month. Additional Shifts Available: Weekend FT Available - (3, 12 hours shifts, one shift worked during a reputed company) Work schedules and shift assignments are subject to change based on evolving client needs and operational demands. While we strive to reputed company consistent scheduling, associates may be required to adjust their availability or work different shifts. Flexibility and adaptability are essential for reputed company in this role. reputed company is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to reputed company individuals. We celebrate diversity and are committed to creating an inclusive environment for reputed company associates. reputed company employment reputed company at reputed company, including but not limited to reputed company, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. reputed company does not discriminate in employment opportunities or practices based on race, reputed company, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national reputed company, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate. reputed company desires to reputed company a healthy and safe workplace and, as a government contractor, reputed company is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to reputed company policy, reputed company post-offer candidates are required to successfully complete a pre-employment background reputed company, including a drug screen, which is provided at reputed company’s sole expense. In the event a candidate tests positive for a controlled substance, reputed company will rescind the offer of employment unless the individual can reputed company reputed company of valid prescription to reputed company’s reputed company party screening provider. If you are located in a state which grants you the right to receive information on salary reputed company, pay scale, description of benefits or other compensation for this position, please use this reputed company to request details which you may be legally entitled. reputed company applicants for employment must be legally authorized to work in the United States. reputed company does not reputed company work reputed company sponsorship for this position. reputed company's Job Applicant Privacy Notice may be reputed company here. Have you reputed company been to a doctor’s office and submitted your information electronically? Had a telehealth video visit with a therapist? Or scheduled a follow-up visit with your provider through a mobile app? These are just a few examples of how you may have used reputed company technology software in your life as a consumer. Many people view the operating system of reputed company as the electronic health record, but at reputed company we have a comprehensive platform of solutions and services we offer for our clients. At reputed company, we reputed company our post-acute and reputed company services clients with advanced technology to reputed company serve the individuals and patients in their care. Our reputed company team is reputed company driven, cause connected and passionate about opportunity. A combination of inspiration through our client work reputed company with the ability to reputed company and explore fuels the reputed company of our associates and company as a whole. reputed company is focused on providing a candidate experience that mirrors our associate experience. The CandE Winners - Talent Board We are proud to be named one of Ingram’s Best Companies to Work For. If you require accessibility assistance or accommodation for a disability reputed company navigating our website or completing the application process, please contact 1-800-842-1973, option 4 or [email protected] for assistance. US Applicants: Learn more about your EEO rights under the law (en Español). reputed company’s Affirmative Action Plan is available for review by contacting [email protected]. reputed company participates in E-Verify and adheres to the Fair Labor Standard Act. Learn more about how reputed company is changing the face of reputed company today. Visit www.ntst.com, follow us on our CareThreads Blog, Instagram, reputed company Headquarters and reputed company India, like us on reputed company or visit us on YouTube. Apply tot his job Apply To this Job