Utilization Review Nurse (PRN)

Netsmart • North Little Rock, AR

2d • Remote

About The Position

This role involves reviewing and evaluating electronic medical records of emergency department admissions to screen for medical necessity using InterQual or MCG criteria. The nurse will apply evidence-based clinical guidelines to ensure proper utilization of healthcare resources, participate in telephonic discussions with physicians regarding documentation and admission status, and enter clinical review information into a system for transmission to insurance companies for authorization. Additionally, the role requires reviewing and analyzing utilization patterns and trends to identify problems or inappropriate resource utilization.

Requirements

• Current 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 concurrent reviews
• Intermediate level experience with InterQual and/or MCG criteria within the last two years
• Proficiency in medical record review in an electronic medical record (EMR)
• Experience in Microsoft Suite including Office and basic Excel
• Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs
• Passing score(s) on job-related pre-employment assessment(s)
• Comfortable with remote work arrangements and virtual collaboration tools
• All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.

Nice To Haves

• 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 within 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)

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 healthcare 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

Benefits

• Equal employment and advancement opportunities to all individuals
• Celebration of diversity and commitment to creating an inclusive environment for all associates
• Netsmart desires to provide a healthy and safe workplace
• Drug-free workplace
• Pre-employment background check, including a drug screen, at Netsmart’s sole expense

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level