Utilization Review Nurse- Full-Time (Days, Evenings & Nights)

Responsibilities

Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual.

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

Current RN licensure

At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing

At least 3 years case management, concurrent review or utilization management experience

Experience with InterQual

Proficiency in medical record review

Preferred

Case management/concurrent review/utilization management experience within the ED setting

Bachelors of Science in Nursing

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 able 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 able to listen and exchange accurate information.

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, 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.