Utilization Review Nurse - RN

Job Summary

A company is looking for a Utilization Review Nurse to perform utilization review work for emergency admissions and continued stay reviews.

Key Responsibilities

• Review electronic medical records of emergency department admissions for medical necessity using InterQual or MCG criteria
• Participate in telephonic discussions with emergency department physicians regarding documentation and admission status
• Enter clinical review information into the system for transmission to insurance companies for authorization

Required Qualifications

• Current RN licensure
• At least 3 years of clinical experience in an acute care setting (emergency room, critical care, or medical/surgical nursing)
• At least 2 years of 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)