Utilization Review Nurse - RN

VirtualVocations
Olympia Heights, Florida, United States
Full-time

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

Key ResponsibilitiesReview electronic medical records of emergency department admissions for medical necessity using InterQual or MCG criteriaParticipate in telephonic discussions with emergency department physicians regarding documentation and admission statusEnter clinical review information into the system for transmission to insurance companies for authorizationRequired QualificationsCurrent RN licensureAt 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 reviewsIntermediate level experience with InterQual and / or MCG criteria within the last two yearsProficiency in medical record review in an electronic medical record (EMR)

18 days ago
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