Utilization Review Nurse, PRN

🕒 August 10

🇺🇸 United States – Remote

⏱ Part Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 44%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Netsmart

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1973

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

Netsmart is a leading provider of comprehensive EHR solutions tailored for a wide range of care settings, especially in behavioral health, addiction treatment, autism, geriatrics, and intellectual and developmental disabilities. The company offers a range of software products that streamline operations, enhance care coordination, and promote value-based care across healthcare communities. In addition to EHRs, Netsmart provides technology solutions for care coordination, telehealth, population health management, and revenue cycle management, aiming to support the delivery of integrated and person-centered care. Their solutions are used in a variety of sectors including human services, post-acute care, and public health, making Netsmart a significant player in the healthcare technology industry.

📋 Description

• 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 • Collaborate through remote work arrangements and virtual collaboration tools

🎯 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) • All applicants for employment must be legally authorized to work in the United States • Netsmart does not provide work visa sponsorship for this position • Preferred: At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing • Preferred: At least 3 years utilization management experience within the hospital setting • Preferred: Bachelor's of Science in Nursing (BSN) • Preferred: Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), Case Management, Board Certified (CMGT-BC)

🏖️ Benefits

• Part-time employment • Equal employment and advancement opportunities • Pre-employment background check and drug screen provided at Netsmart’s sole expense