Utilization Review Nurse - Full-Time - Multiple Shifts Available (Including Weekend Shifts) Remote - Other

This position is a critical part of utilization management reputed company the emergency department setting. The role ensures that patient admissions meet medical necessity standards and that reputed company resources are used appropriately and reputed company. It combines clinical expertise, analytical skills, and communication abilities to support both patient care and organizational compliance.

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
• Bachelors 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 or 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. Netsmarts Job Applicant Privacy Notice may be reputed company here. Apply tot his job Apply To this Job