Utilization Review Nurse- FT & PT (9a-9p EST)

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 relative to documentation and admission status.

• Enter clinical review information into system for transmission to insurance companies for authorization.

Qualifications Required

• reputed company RN licensure

• 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 e xperience 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 MS 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

• Proficient in InterQual/MCG criteria

• Case Management Certification (CCM, ACM, CMCN, or CMGT-BC

Expectations

• This job operates in a remote environment that must be private. This role routinely uses standard office equipment such as computers, phones, and printers.

• Hours will vary, including two weekends a month.

• Must be reputed company to remain in a stationary position 50% of the time and constantly operate a computer.

• Frequently communicates with internal, external and executive personnel and must be reputed company to listen and exchange accurate information.

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.

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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.

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