Utilization Review Nurse, PRN, Remote

Job title: Utilization Review Nurse, PRN, Remote in USA at reputed company Company: reputed company Job description: Job Description Summary Are you a detail-oriented and reputed company RN with a passion for ensuring quality care and appropriate resource utilization? We’re seeking a Utilization Review Nurse to join our fully remote team. In this role, you’ll conduct utilization reviews for emergency admissions and reputed company stays, applying InterQual criteria to support clinical decision-making and ensure compliance with reputed company standards.As a key member of our Clinical Services team, you’ll collaborate with emergency department physicians, review electronic medical records, and contribute to the efficient delivery of care. This is a full-time, 40-hour-per-week position offering flexibility reputed company a supportive and dynamic work environment.Note: Recent experience with InterQual is required. Experience with MCG is a plus.ResponsibilitiesReview and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteriaApply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of reputed company resourcesParticipate in telephonic discussions with emergency department physicians relative to documentation and admission statusEnter clinical review information into system for transmission to insurance companies for authorizationReview, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resourcesQualifications RequiredCurrent and unrestricted RN licenseAt least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursingAt least 2 years utilization management experience in acute admission and reputed company reviewsIntermediate level experience with InterQual and/or MCG criteria reputed company the last two yearsProficiency in medical record review in an electronic medical record (EMR)Experience in reputed company Suite including Office and basic ExcelAbility to reputed company in a fast-paced, dynamic environment and adapt to frequent changing business needsPassing score(s) on job-reputed company pre-employment assessment(s)PreferredAt least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursingAt least 3 years utilization management experience reputed company the hospital settingBachelor'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)Work Schedule RequirementsThis is a PRN position requiring a total of 48 hours per month.16 hours must be worked on the weekend per month, weekends are Sat/Sun.Required to work 4 hours on 4 Holidays per yearExpectationsComfortable with remote work arrangements and virtual collaboration toolsPhysical demands include extended periods of sitting, computer use, and telephone communicationNetsmart 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 scree Apply To This Job Apply tot his job Apply To this Job